Isolated Marrow Tuberculosis Presenting as Pure Red Cell Aplasia: A Case Report

Case Report

J Blood Disord. 2015;2(2): 1025.

Isolated Marrow Tuberculosis Presenting as Pure Red Cell Aplasia: A Case Report

Das K¹*, Patil V¹, Pai S², Bhat RR² and Dixit A¹

Department of Hematology, Manipal hospital, India

Department of Pathology, Manipal Hospital, India

*Corresponding author: Das K, Department of Hematology, Medical Oncology and Transplant, Manipal hospital, #98 Rustum Bagh, HAL Road, Bangalore 560017, India.

Received: February 09, 2015; Accepted: May 11, 2015; Published: May 19, 2015


Pure Red Cell Aplasia (PRCA) is a rare hematological condition. It has been associated with various viral, toxic or idiosyncratic insults. Tuberculosis involving erythroid precursors in isolation and presenting as pure red cell aplasia has not been described in literature. We report a case of otherwise asymptomatic 22 years male, who presented with pure red cell aplasia refractory to conventional therapy and later diagnosed to have tubercular involvement of bone marrow. He showed complete recovery of anemia with anti tubercular therapy.

Keywords: Pure red cell aplasia; Tuberculosis; Anemia


Pure red cell aplasia is a condition of isolated suppression of erythroid precursors. Association of viruses, drugs and radiation has been documented. Tuberculosis has myriad of hematological manifestations. Disseminated tuberculosis has been associated with severe pancytopenia commonly. Most of the hematological manifestations are also complications of anti-tubercular drugs rather than disease itself. We report a unique case of tuberculosis presenting as pure red cell aplasia without any systemic symptom or sign.

Case Summary

A 22 years old male presented with increasing fatigue and tiredness from 2 months. His clinical examination was unremarkable with no lymphadenopathy or organomegaly although marked pallor was evident. There was no history of fever, rash, joint pain, significant weight loss or any medication in recent past. His personal, occupational and family history was non contributory. He was evaluated at another health facility. Lab investigations done there showed normocytic anemia with normal leucocytes and platelet count. Bone marrow aspiration was normocellular with paucity of erythroid precursors. CT chest excluded thymoma. He was diagnosed to have pure red cell aplasia based on bone marrow findings. He was started on oral steroid based therapy [prednisolone 2mg/ kg/day for 2 weeks followed by slow taper] along with red cell transfusion support. Danazol [200mg twice a day] was added as well after 6 weeks in view of no response. He remained transfusion dependent and after 3 months referred to our centre for further management. He was reevaluated further. His initial lab investigations showed normocytic anemia with normal leucocytes and platelet count (Table). Serology for hepatitis B, hepatits C and human immunodeficiency virus were negative. Bone marrow aspiration showed normocellular marrow with erythroid hypoplasia. Bone marrow biopsy showed normal cellularity, presence of granulomas along with isolated paucity of erythroid precursors. Ziehl-Neelson staining showed presence of acid fast bacilli (Figure). Thorough systemic assessment was done to find the primary tubercular focus but no other systemic involvement was noted. He was started on four drugs anti Koch’s treatment (AKT; rifampicin, isoniazide, ethambutol and pyrazinamide). Steroid and Danazol were withdrawn. He became transfusion independent after 3 weeks of AKT. He was treated with 2+10 months of AKT (4 drugs AKT for 2 months followed by 2 drugs AKT for 10 months). He is off therapy for more than 1 year and there is no recurrence of anemia.

Citation: Das K, Patil V, Pai S, Bhat RR and Dixit A. Isolated Marrow Tuberculosis Presenting as Pure Red Cell Aplasia: A Case Report. J Blood Disord. 2015;2(2): 1025. ISSN 2379-8009