Diagnosis Value of Bone Marrow Study in the Disseminated Infection by Mycobacteria: Case Report

Abstract

The bone marrow examination is useful in order to get an etiologic diagnosis of cytopenias and for the detection of opportunistic diseases in immunocompromised patients. Nevertheless, its role in the diagnosis of invasive infections caused by mycobacterium has not been clearly defined. We describe the case of a 42-year-old woman who was admitted to study anemia, diarrhea and constitutional syndrome during two months with medical history of human immunodeficiency virus-1 infection, old intravenous drug user, hepatitis C virus carrier, as well as having lymph node tuberculosis and tuberculous meningitis during six years. The hematologic assessment was requested for the peripheral blood examination, which showed severe hyporegenerative anemia, rouleaux, anisopoikilocytosis and neutrophilia. In the bone marrow biopsy imprint we observed a very hypoplastic eritroid series and many macrophages with spread granularity and cytoplasm, similar to the Gaucher’s cells, which presented erythrophagocytosis and birefringence enlarge forms scattered throughout the smear, suggesting mycobacteria, with these findings, we established the diagnostic suspicion of disseminated mycobacterial disease and started the empirical treatment for Mycobacterium avium intracellulare-tuberculosis on the same day of the procedure, the etiology infection was later confirm by cultures. In this case, the bone marrow examination allowed to establish an early diagnostic suspicion from the hematology laboratory and to start the treatment before the microbiologic result.