Tuberculosis of the bone marrow: clinico-pathological study of 22 cases from Saudi Arabia

To study the clinical and pathological patterns of tuberculosis (TB) involving the bone marrow in a tertiary care setting.

A retrospective study of cases of bone marrow TB diagnosed and treated at King Faisal Specialist Hospital and Research Center from 1990 to 2002. The main criterion for inclusion was the isolation of Mycobacterium tuberculosis from a bone marrow specimen.

We identified 22 patients with culture-proven M. tuberculosis infection of the bone marrow. Underlying conditions found in this series include solid organ transplantation in 4 patients (18%), HIV infection in 2 (9%), and diabetes in 3 (14%). No risk factor was identified in 12 patients (55%). Histopathological findings were reported as granuloma in 19 patients (86%) and caseating granuloma in 3 (14%). The outcome was favourable for 11 patients (50%), while 10 (45%) died during hospitalisation and one was lost to follow-up. For patients who completed their regimens, the duration of treatment was 12 months.

The isolation of M. tuberculosis from a bone marrow specimen is an indication of disseminated disease which carries a high mortality rate and requires prompt initiation of appropriate treatment.