Peripheral blood and marrow findings in disseminated bacille Calmette-Guerin infection
Perikala Vijayananda Kumar1, Ahmad Monabati, Rahim Kadivar
1Department of Pathology, Shiraz Medical School, Shiraz, Iran. kumarv@sums.ac.ir
Insights
A rare disseminated bacille Calmette-Guerin (BCG) infection caused severe hepatosplenomegaly and pancytopenia in an infant. Unique autopsy findings included Gaucher cell-like macrophages and marrow necrosis, previously unreported in disseminated BCG disease.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pathology
Background:
- Disseminated bacille Calmette-Guerin (BCG) infection is a rare but serious complication, particularly in immunocompromised infants.
- Initial clinical presentation can mimic other severe pediatric conditions such as infantile kala-azar, lymphoma, or leukemia.
Observation:
- A 3-month-old female infant presented with massive hepatosplenomegaly, fever, and pancytopenia.
- Despite initial suspicion of other conditions, investigations confirmed disseminated BCG infection.
Findings:
- Autopsy revealed diffuse histiocytic infiltration in the liver, spleen, and mesenteric lymph nodes heavily laden with acid-fast bacilli.
- Unique findings included monocytes with ghost acid-fast bacilli, Gaucher cell-like macrophages containing negative images of Mycobacterium tuberculosis in bone marrow, and extensive marrow necrosis.
- These specific pathological findings have not been previously documented in the literature.
Implications:
- This case highlights the importance of considering disseminated BCG infection in infants with severe systemic symptoms and cytopenias.
- The novel pathological observations may offer new insights into the host-pathogen interaction in disseminated BCG infection.
- Further research is warranted to understand the mechanisms behind these unique findings and their clinical significance.
Abstract:
The authors describe an unusual case of a disseminated bacille Calmette-Guerin (BCG) infection in a 3-month-old girl who presented with a huge hepatosplenomegaly, fever, and pancytopenia. Clinically, an infantile kala-azar or lymphoma/leukemia was suspected. However, after thorough clinical and paraclinical investigations, the case was diagnosed as a disseminated BCG infection. The child died 2 weeks after starting antituberculosis treatment. Autopsy revealed diffuse histiocytic infiltration in the liver, spleen, and mesenteric lymph nodes, which were loaded with acid-fast bacilli. Three interesting findings were noticed in this case: circulating monocytes in the peripheral blood were loaded with ghost acid-fast bacilli; bone marrow smears revealed numerous Gaucher cell-like macrophages loaded with negative images of Mycobacterium tuberculi; and there was extensive marrow necrosis. These findings have not been previously reported in the literature.
