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[Diagnosis and treatment of tuberculosis of bone marrow]
1Department of Internal Medicine, First Affiliated Hospital, West China University of Medical Sciences, Chengdu 610041.
Objective:
To explore appropriate diagnosis and treatment of tuberculosis of bone marrow.
Method:
Clinical and pathologic data of 11 cases with tuberculosis of bone marrow out of 2,410 cases underwent biopsy from 1990 to 1997 were retrospectively analyzed.
Result:
High fever, weariness, emaciation and anaemia were found in 11 cases, abdominal distension and abdominal pain in 4, ascites in 3, liver and spleen enlargement in 5. All the cases had no local osteoarticular abnormalities. Negative sputum smear acid-fast staining results were found in 11 cases, abnormal liver function in 9, increased erythrocyte sedimentation rate (30-168 mm/1 h) in 6 detected. Chest radiographs showed hematogenous disseminated pulmonary tuberculosis in 4 cases, no tuberculous lesion in 7. Tuberculous granulomas were found in 11 cases, caseous necrosis in 6, and positive granulomatous tissue acid-fast staining results in 3. Ten out of 11 cases accompanied tuberculous lesions in other parts of body except bone marrow. Eight cases recovered after combined antituberculosis chemotherapy, and other 3 died.
Conclusion:
Tuberculosis of bone marrow is the bone marrow involvement of hematogenous disseminated tuberculosis with nonspecific manifestations. Possibility of hematogenous disseminated tuberculosis should be considered in patients with long-term high fever, and in addition to common pulmonary abnormalities, the bone marrow biopsy should also be taken into consideration. Moreover, combined antituberculosis chemotherapy should be given immediately after the diagnosis of the disease.