Myelofibrosis secondary to tuberculosis in a child with Down’s syndrome: A case report

Introduction: Tuberculosis and myelofibrosis (MF) are reported to co­exist. There seems to be a definite relationship between the two entities, possibly tuberculosis stimulating a secondary fibrotic reaction. Occurrence of myelofibrosis in Down’s syndrome has also been increasingly recognized. The purpose of this article is to present a unique case of Down’s syndrome who developed myelofibrosis secondary to tuberculosis of the bone marrow. Case Report: A 14­years­old female child, already a documented case of Down’s syndrome, proved on cytogenetic analysis, reported to our institute with fever of five days duration and bleeding from nose and mouth. Clinical examination revealed features of Down’s syndrome and hematological parameters showed pancytopenia. Bone marrow aspiration revealed a dry tap. Bone marrow biopsy showed hypocellular marrow with tubercular granulomas and increased bone marrow reticulin fibres, findings compatible with myelofi brosis secondary to tuberculosis. Conclusion: Myelofibrosis in paediatric age group is usually secondary to an underlying disease entity of haematopoietic or non­ haematopoietic origin. Among the non­ haematopoietic diseases, tuberculosis shows a frequent association. Moreover, the patients of Down’s syndrome have disturbances of hematopoiesis with an increased incidence of myeloproliferative disorders like myelofibrosis. Such patients suffering from other diseases like tuberculosis are more prone to develop myelofibrosis as seen from the present case report. A detailed investigation and extensive search for evidence of tuberculosis should be made in these children presenting with myelofibrosis.