Though commonly encountered, extrapulmonary tuberculosis (TB) can sometimes present with variable clinical picture intricating the diagnosis. The nonspecific symptoms include pyrexia of unknown origin, hepatosplenomegaly, lymphadenopathy, meningitis, and, rarely, variety of hematological abnormalities, namely, anemia, pancytopenia, and leukemoid reaction. When it presents with bone marrow (BM) involvement, prognosis is usually poor. We, hereby, report a case of unusual TB presentation with a 4 month history of fever associated with fatigability, and diarrhea. During the hospital stay and follow up, the patient showed a spectrum of interesting hematological findings, including pancytopenia on peripheral smear, caseating granulomas consistent with TB on bone marrow examination. The patient showed a good clinical as well as hematological response to anti-tuberculosis treatment. This paper highlights the significance of a hematological picture in the final confirmation of TB, which may otherwise be passed off as nutritional or other unrelated causes.
PUO, Pancytopenia, Tuberculosis, Bone-marrow