Clin Pediatr Hematol Oncol.  2009 Oct;16(2):139-144.

A Case of Disseminated Tuberculosis in a Pediatric Patient after Matched Sibling Bone Marrow Transplantation

• Joung JK
• Lee KH
• Lee JW
• Yoon JS
• Lee DG
• Chung NG
• Cho B
• Kang JH
• Lee JS
• Kim HK

Abstract

Mycobacterium tuberculosis (TB) infection is seldom diagnosed after hematopoietic stem cell transplantation, but may cause significant morbidity in countries where TB is endemic. The signs and symptoms of infection usually become apparent months after engraftment, often concurrent with acute or chronic graft-versus-host disease. We report a case of rapid onset post-hematopoietic stem cell transplantation (HSCT) TB in a pediatric acute myeloblastic leukemia patient who received matched sibling bone marrow transplantation and was diagnosed with disseminated TB of the lungs and marrow within a month of transplantation. The patient was initially given a five drug anti-TB regimen that was modified three times during the course of treatment. Although follow-up acid fast bacilli (AFB) cultures became negative, the patient experienced acute sepsis, disseminated intravascular coagulation (DIC) and pulmonary hemorrhage that resulted in fatality. As methods of screening and prophylaxis are still questionable, TB should always be given due consideration as a cause of post-HSCT fever in regions where its incidence is high, regardless of time of onset of first symptoms.

Keyword

Mycobacterium tuberculosis; Pediatric bone marrow transplantation; Sepsis

MeSH Terms

Bone Marrow
Bone Marrow Transplantation
Disseminated Intravascular Coagulation
Fever
Follow-Up Studies
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Hemorrhage
Humans
Incidence
Leukemia, Myeloid, Acute
Lung
Mass Screening
Mycobacterium tuberculosis
Sepsis
Siblings
Stem Cell Transplantation
Transplants
Tuberculosis