#00060525

55 Years female presented with the history of fever, weakness and weight loss for two months. Examination reveals pallor, rest of examination is unremarkable. Base line CBC shows pancytopenia and reticulocytopenia. Bone marrow done for workup.

PERIPHERAL BLOOD COUNTS:

HB:              8.2 G/DL

HCT:             25.0 %

MCV:             72.5 FL

MCH:             23.8 PG

WBC'S:           3.8 x 10E9/L

ANC:             3.1 x 10E9/L

PLATELETS:       129 x 10E9/L

CORRECTED RETICULOCYTE COUNT: 0.8%

Her peripheral blood film showed anisocytosis, hypochromia, microcytosis, poikilocytosis and elliptical cells. Bone marrow aspirate was hypocellular specimen. Bone trephine biopsy showed trilineage Haematopoiesis along with multiple well defined large areas of non-caseating granulomas exhibiting lymphohistiocytic collection along with plasma cells. Many epitheloid cells were visible along with few giant cells. ZN stain was applied but was negative for AFB.

Considering the history of fever and granulomatous inflammation, Tuberculosis was top amoung Differential diagnosis Unfortunately patient was lost to follow up because of financial constraints.