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IMAGE IN HEMATOLOGY
Year : 2016  |  Volume : 7  |  Issue : 3  |  Page : 114-115

Bone marrow tuberculosis in a known case of Kikuchi disease and miliary tuberculosis


1 Department of Pathology, Hematology Unit, King Fahad Hospital, Madina and King Saud Fellowship, Kingdom of Saudi Arabia
2 Department of Pathology, Hematology Unit, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia

Date of Web Publication26-Oct-2016

Correspondence Address:
Ahmad Ali Alharbi
Department of Pathology, Hematology Unit, King Fahad Hospital, Medina
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-5127.192982

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How to cite this article:
Alharbi AA, Alfaraedi A. Bone marrow tuberculosis in a known case of Kikuchi disease and miliary tuberculosis. J Appl Hematol 2016;7:114-5

How to cite this URL:
Alharbi AA, Alfaraedi A. Bone marrow tuberculosis in a known case of Kikuchi disease and miliary tuberculosis. J Appl Hematol [serial online] 2016 [cited 2022 Aug 19];7:114-5. Available from: https://www.jahjournal.org/text.asp?2016/7/3/114/192982

A 41-year-old male, K/C of Kikuchi disease and hypertension, who admitted with miliary tuberculosis (TB) and low platelets. His peripheral blood smear show left shifted granulocytes with toxic changes and prominent monocytes. Thrombocytopenia was confirmed. The bone marrow aspirate was an particulate but cellular showing occasional megakaryocytes, increased granulopoiesis with toxic granulation and prominent histiocytes. Bone marrow trephine biopsy was tiny. However, it showed well-defined area of granuloma with necrotizing epithelioid histiocytes, occasional giant cells, necrotic background, and inflammatory cells. CD163 reveals increased histiocytes all over the biopsy. Moreover, the granulomatous lesion was well delineated by CD163 positive histiocytes. Ziehl–Neelsen stain confirmed the tuberculous origin of this granuloma by the presence of occasional acid-fast bacilli within the lesion. Hence, diagnosis of bone marrow involvement by miliary TB associated with secondary histiocytosis mostly due to Kikuchi disease was made [Figure 1],[Figure 2],[Figure 3],[Figure 4].
Figure 1: The epithelioid granuloma in bone marrow trephine biopsy (H and E, ×20)

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Figure 2: CD163 positive histiocytes delineating the granulomatous lesion, ×20

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Figure 3: CD163 positivity within the granuloma and all over the bone marrow, ×10

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Figure 4: Acid-fast bacilli detected by Ziehl–Neelsen stain, ×100

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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