Bone Marrow Granulomas Research Articles

Contribución al conocimiento de la patología de la brucelosis

1) Se presenta el estudio anátomo-patológico de 6 casos mortales de brucelosis, en 4 de los cuales se hizo la verificación bacteriológica post-mortem por inoculación de suspensiones de machacados de bazo, ganglio s linfáticos e hígado en cobayos, aislándose brucela melitensis en todos los casos. En el cuarto comprobamos, además, aglutinaciones positivas en líquido pleural y en el quinto en el líquido ascítico. 2) Se describe las siguientes lesiones brucelósicas que no se ha encontrado relatadas en la Iíteroturc revisada: a) Atrofia subaguda de hígado, comprobada a brucela melitensis por hallazgo del germen en muestras de hígado. b) Meningoencefalitis y meningitis a brucela melitensis; casos con verificación bacteriológica. c) Granulomas brucelósicas en las glándulas suprarrenales. d) Granulomas brucelósicas en las trompas; caso con verificación bacteriológica. 3) Se destaca la frecuencia e importancia de las lesiones vasculares, presentando casos de endoflebitis en vasos esplénicos y renales. Se interpreta las trombosis y aneurismas repetidamente señalados en la literatura, como resultado de aquellas. 4) Se presenta un caso de hepatitis intensa brucelósica, de evolución clínica prolongada, en el que se encuentra imágenes histológicas de pre-cirrosis. 5) Se señala que en nuestro medio el compromiso hepático de intensidad mediana o grande es más frecuentes que en otros, lo cual puede explicarse, en parte, por asociación de déficit nutricional que agrava la injuria sobre el hígado. Se distinguen los siguientes tipos clínico-patológicos de compromiso hepático: hepatitis inaparente; hepatitis aguda o subaguda; hepatitis crónica (pre-cirrosis y cirrosis) y atrofia subaguda o aguda de hígado. 6) Se describe las siguientes lesiones brucelósicas iguales a las relatadas por otros autores: nefritis intersticial, miocarditis, peritonitis, hepatitis y granulomas brucelósicos en ganglio s linfáticos y bazo. 7) Se presenta pruebas anatómicas de la reactivación de focos tuberculosos antiguos, detenidos, ocurrida en el curso de la infección brucelósica, discutiéndose la inter-relación de los dos procesos. 8) Se llega a la conclusión de que no existe una respuesta tisular uniforme a la agresión brucelar. Las alteraciones fundamentales se desarrollan en el RES, pero también otros tejidos reaccionan. Se distingue los siguientes tipos de respuesta inflamatoria: a) Hiperplasia del RES b) Inflamaciones infiltrativo-proliferativas y c) Inflamaciones exudativo-infiltrativas. Estas diversas reacciones pueden ocurrir en un mismo sujeto. Las tres pueden presentarse, ya en forma difusa, como infiltrados no circunscritos, o a la manera verdaderamente granulomatosa en focos circunscritos, netos. El granuloma constituido por la necrosis de grandes focos de células mononucleares de amplio protoplasma ha sido la figura más típica encontrada. La diversidad del cuadro anátomo patológico se interpreta como dependiente de la hipersensibilidad, resistencia, virulencia y número de gérmenes, aduciéndose observaciones sobre la importancia de cada una de esas variables. 9) Se presenta el resultado de las observaciones clínicas y anátomo patológicas en más de 35 cobayos infectados con una de las cepas de brucela melitensis aislada en los casos de autopsia humana. Se señalan alteraciones leves en el cuadro hemático en el curso de la infección y se destaca la rapidez de aparición de aglutinaciones positivas en los animales infectados con productos de autopsia. 10) Se describen los caracteres histológicos de la reacción de hipersensibilidad en el cobayo. 11) Se hace un estudio de la sucesión de fenómenos desencadenados en el cobayo por la inyección intracutánea de brucelas, dando los caracteres macro y microscópicos escalonados de la reacción. En el curso de esta experiencia se demostró experimentalmente la multiplicación intracelular del germen habiéndose seguido cuantitativamente, día a día, el incremento del número de brucelas en el foco inflamatorio desarrollándose en los macrófagos. El 100% de parasitismo se observó al 13 avo día. 12) Se estudia el efecto de la reinfección en el cobayo comprobándose que ésta da lugar a lesiones más rápidas, agudas, necróticas y que involucionan precozmente en relación con los primo-infectados. 13) Se presenta el resultado de las observaciones clínicas y anátomo patológicas realizadas en perros infectados con brucela melitensis. Se comprueba el alto grado de resistencia natural de este animal. Como en otras infecciones la esplenectomía disminuiría la resistencia a la inoculación con brucelas. 14) Se estudia el efecto local de la primo-infección brucelósica en el perro, encontrándose que, en relación con los cobayos, la reacción inflamatoria y la ulceración aparecen más rápidamente, la involución es precoz y no se hace evidente multiplicación activa de los gérmenes. 15) Se estudia el efecto de la reinfección intradérmica e intravisceral en el perro, comprobándose lesiones más necróticas e intensas que en los primo-infectados, las cuales se atribuyen al desarrollo, en alto grado, de hipersensibilidad bacteriana. Se presenta observaciones experimentales del efecto de los traumatismos sobre la sintomatología regional.

Functional Imaging in Extrapulmonary Sarcoidosis

Sarcoidosis is a multiorgan granulomatous disease of unknown etiology that primarily involves the lungs and the lymphatic system. Extrapulmonary sarcoidosis is common, occurring in 30 to 50% of patients. In this review, we describe and illustrate the role of F-FDG PET/CT and MR imaging in patients with extrapulmonary sarcoidosis. FDG-PET/CT and MR can improve the accuracy of the diagnosis of extrapulmonary involvement, specify the respective contributions of active and fibrotic components of lesions, guide the selection of the biopsy site, provide prognostic information, and guide therapeutic management. We focus on suggestive patterns that help to improve lesion characterization, especially when these lesions are clinically occult. In cardiac sarcoidosis, the combined use of FDG-PET/CT and cardiac MR may provide optimal detection of the disease by enabling the differentiation between patients with active granulomatous inflammation and those with fibrous lesions. In cases with central nervous system involvement, the T2 hypointensity of the dural and parenchymal lesions is helpful for identifying sarcoidosis. Granulomatous bone marrow infiltration in the axial skeleton can be sensitively detected by both FDG-PET/CT and MR. Muscular sarcoidosis can have a characteristic appearance with the "dark star" sign on MR and a thick linear FDG uptake that predominantly involves the lower legs, designated as the "tiger man" sign. Extrathoracic lymphadenopathy is commonly observed on FDG-PET/CT imaging; however, its features are not specific, and the differentiation of extrathoracic lymphadenopathy from metastatic disease, tuberculosis, or lymphoma may be difficult. Familiarity with the functional imaging features in extrapulmonary sarcoidosis in various anatomical locations plays a crucial role in the diagnosis and management of patients.

Massive accumulation of osteoclastic giant cells in rapid destructive hip disease

The term rapid destructive hip disease (RDHD) designates a rare coxarthropathy characterized by a rapid destruction of the femoral head within a few weeks to several months. The etiology and pathogenesis of RDHD are not understood. The goal of this study was to define the histological and histomorphometric hallmarks of RDHD to provide a basis for a deeper understanding of the underlying mechanisms. Fifteen consecutive RDHD patients (mean age 78.9 ± 6.4 years, 14 females) demonstrated the characteristic radiographic appearance of vanishing femoral head bone stock without signs of reactive anabolic changes. Histologic and histomorphometric analyses revealed severe bone resorption with significantly increased numbers of morphologically altered giant osteoclasts, the formation of giant cell granulomas both in bone marrow and the synovium and significantly increased osteoblast numbers and osteoid as compared to controls with primary osteoarthritis (OA). These results suggest that in RDHD, an unknown stimulus leads to a massive activation of osteoclasts and this in turn provokes a reactive increase in osteoblast activity that is too weak to counteract the rapid destruction of the hip, thus providing a rationale for a prospective systematic search for the stimuli upstream of the massively increased osteoclast activation in RDHD.

Bone Marrow Granulomas: A Retrospective Study of 47 Cases (A Single Centre Experience)

Background: Granulomas in bone marrow are an infrequent finding; however several diseases may be associated with granuloma formation and an etiologic diagnosis is essential. Bone marrow examination plays an important role in the diagnosis of various disorders associated with bone marrow granulomas and is useful in the investigation of pyrexia of unknown origin (PUO) as it leads to an etiological diagnosis in many of the cases. Aim: This study was undertaken to ascertain the frequency and etiological background of bone marrow granulomas. Material and methods: In the present study, forty seven cases with bone marrow granulomas were included. Clinical details, peripheral blood and marrow morphological findings were analyzed. Results: Pyrexia of unknown origin was the commonest presentation and anemia was noted in all cases. Twenty five cases had associated clinical conditions, including 7 with past history of tuberculosis and 8 with retroviral disease. Of the 47 cases, 7 showed granulomas in bone marrow aspiration, while bone marrow biopsy was diagnostic in all cases. Caseous necrosis was seen in 11(23.4%) cases. Acid fast bacilli were demonstrated in one bone marrow aspirate. Culture studies grew Brucella organisms in one case. Tuberculosis was the commonest in the present study as compared to other studies probably due to the endemicity of tuberculosis in this region. Conclusion: If the granuloma is associated with caseous necrosis and Langhan giant cells and correlated with clinical features, a possibility of the tuberculous etiology may be suggested to allow empirical treatment to be initiated before microbiological confirmation.

Mycobacterial bone marrow infections at a medical centre in Taiwan, 2001–2009

Mycobacterial bone marrow (BM) infection is the most common diagnosis established by BM examinations for fever of unknown origin. In this study, clinical features and outcomes of patients who fulfilled the criteria for BM infection due to Mycobacterium tuberculosis (MTB) and non-tuberculous mycobacteria (NTM) at a medical centre in Taiwan from 2001 to 2009 were investigated. The BM histopathological findings were also analysed. A total of 24 patients (16 men, eight women) with mycobacterial BM infections were found. Of these, nine (38%) were positive for human immunodeficiency virus (HIV) and six (25%) had no pre-existing immunocompromised conditions. MTB isolates were obtained from 11 (46%) patients and NTM species were isolated from 10 (42%) patients, including M. avium complex (MAC, n = 7) and M. kansasii (n = 3). Patients with MTB infections were significantly older than those with NTM infections (60·5 vs. 47·7 years, P = 0·043) and were less likely to have a positive BM culture (45% vs. 100%, P = 0·012). The 90-day survival rates for MTB and NTM BM infections were 68% and 60%, respectively (P = 0·61). In addition, the presence of BM granulomas was significantly more common in patients with MTB BM infections than in those with NTM infections (82% vs. 30%, P = 0·030). In Taiwan, the importance of NTM was not inferior to MTB and besides MAC, M. kansasii might be an important pathogen in non-HIV-infected patients. The presence of BM granulomas and caseation provides valuable information regarding early treatment pending culture results.

Granulomatous lesions in bone marrow: Clinicopathologic findings and significance in a study of 48 cases

PurposeGranulomas in bone marrow are an infrequent finding related to various disorders. The aim of this study was to review our clinical experience with granulomatous bone marrow disease and to describe the contributions of recent diagnostic tools, such as 18F-Fluorodeoxyglucose positron emission tomography (18F-FDG-PET) and molecular biology. MethodsClinical, laboratory and morphological data on patients with a granuloma based on bone marrow biopsy analysed in the University Hospital Lyon from May 2004 to July 2010 were reviewed. ResultsWe identified 57 cases among 9641 bone marrow biopsies, representing an incidence of 0.59% in the series and an annual incidence of 9.5 cases per year. Nine biopsies performed for staging a known pathology were excluded from further analysis. Among the 48 remaining patients, associated disease was demonstrated in 79%, with infections being the most common (33%), following by sarcoidosis (21%), malignancy (19%) and therapy-induced granulomas (6%). One previously unpublished entity is described: infection with Bartonella henselae diagnosed using molecular biology from node and skin biopsies in two renal transplant patients. 18F-FDG-PET, performed in 13 cases, showed hypermetabolic foci consistent with sarcoidosis in two cases. Positive PCR result for an infectious pathogen was obtained in three bone marrow samples (Mycobacterium tuberculosis, n=1; Mycobacterium genavense, n=2). ConclusionIn comparison to previous research, our study reports high proportions of cases caused by sarcoidosis and unknown causes. 18F-FDG-PET could show signs consistent with sarcoidosis and molecular biology is useful for the detection of fastidious bacteria in immunocompromised patients.

Prominent granulomas in bone marrow in disseminated lymphoma with hemophagocytic syndrome

Prominent granulomas in bone marrow in disseminated lymphoma with hemophagocytic syndrome

Sarcoid-like granulomatosis in patients treated with anti-TNFα factors. A case report and review of the literature

This report describes a 56-year-old woman who developed granulomatous lesions consistent with sarcoidosis during adalimumab therapy for rheumatoid arthritis. Cervical and axillary lymphadenopathy developed approximately 21months after adalimumab administration. Non-caseating epithelioid cell granulomas consistent with sarcoidosis were detected both in an axillary lymph node specimen and in the bone marrow. Diseases showing similar histologic changes, especially tuberculosis, were excluded, and a diagnosis of sarcoidosis was made. Adalimumab was discontinued, and recovery was observed. The current case is, to our knowledge, the first to describe adalimumab-induced non-caseating granulomas in lymph nodes and bone marrow without pulmonary involvement in a patient treated for rheumatoid arthritis.

Amiodarone-Induced Bone Marrow Granulomas: An Unusual Cause of Reversible Pancytopenia

Bone marrow infiltration by granulomas rarely presents with cytopenias and is usually a result of atypical infections, lymphomas, or sarcoidosis. Drugs are also an important but often overlooked causal agent of bone marrow granulomas. Although rare, amiodarone has been associated with bone marrow granuloma formation. This case report describes a 73-year-old male who presented with pancytopenia during a preoperative evaluation. Amiodarone therapy was suspected to be the causal agent after diagnostic evaluation and exclusion of other causes. After cessation of amiodarone, the patient's pancytopenia gradually resolved over a period of several months. Our report illustrates an often overlooked yet important cause of reversible pancytopenia owing to suspected amiodarone-induced bone marrow granuloma formation, and guides clinicians in an expected timeline for blood count improvement after cessation of this drug.

Pancytopenia in a patient with Lyme disease

Lyme disease, caused by Borrelia burgdorferi, is the most common vector-borne disease in USA [1]. Its most frequent clinical features include skin manifestations and fever [2]. Hematologic manifestations are unusual in solitary infections with B burgdorferi. We report what we believe is the first documented case of pancytopenia triggered by Lyme disease. An 86-year-old Caucasian woman residing in rural Connecticut was hospitalized with generalized weakness leading to a fall at home. She had no other medical problems and was independent for all activities of daily living. She reported a tick bite while gardening about 2 months before and had received prophylaxis with single-dose doxycycline. Examination showed normal vital signs and a large 10 9 10 cm bruise on her left buttock attributed to the fall. No other skin lesions were apparent. Cardiovascular examination showed a systolic murmur loudest at the apex. Examination of the respiratory system, abdomen, and central nervous system were normal. Laboratory evaluation at admission showed: WBC 3900/mm (neutrophils 3500/mm, lymphocytes 200/mm); Hb 12.9 g/dL; platelets 60,000/mm; PT 11.9 s; INR 0.95; PTT 28.0 s; sodium 142 meq/L; potassium 3.9 meq/L; chloride 99 meq/L; bicarbonate 23 meq/L; BUN 21 mg/dL; creatinine 1.32 mg/dL; glucose 123 mg/dL; CPK 4515 u/L; AST 326 u/L; ALT 116 u/L; alkaline phosphatase 110 u/L; and LDH 1495 u/L. Blood reticulocytes was 0.2% suggesting suppression of RBC production. She was hospitalized with a diagnosis of rhabdomyolysis and acute kidney injury. Over the next two days, she developed worsening pancytopenia (Fig. 1). Given the history of tick bite, she was started on doxycycline on day 2, following which her cell lines showed improvement. The patient’s Lyme titer was positive at 2.84 [normal range 0–0.99]. IgG Lyme Western blot showed p18, p23, p28, p30, p31, p34, p39, p41, p45, p58 and p66 (diagnostic if C5 of: 18, 23, 28, 30, 39, 41, 45, 58, 66 and 93 kDa bands are present), and IgM Lyme Western blot showed bands p23, p31, p34, p41 and p66 (diagnostic if C2 of: 23, 39 and 41 kDa bands are present). IgG and IgM for Anaplasma phagocytophila and Ehrlichia chaffensis and blood smear for Ehrlichia were negative. Hepatitis A, B, and C serologies were negative. EBV IgG was positive, and IgM was negative. Antibodies to Coxsackie viruses B1B6 were non-diagnostic. Legionella antigen, Enterovirus PCR, and blood smear for Babesia microti were negative. ANA and platelet PF4 antibody assays were also negative. By the 6th hospital day her cell lines had recovered and renal functions normalized, and she was discharged home. While it is well-recognized that B. burgdorferi causes systemic disease, its hematologic manifestations are not widely reported. During the initial dissemination phase, B. burgdorferi seeds the bone-marrow [3]. Various reports have recognized thrombocytopenia and bone marrow granulomas as hematologic manifestations of Lyme disease [4–6], although pancytopenia has not previously been described. Making a diagnosis of Lyme-related pancytopenia is dependent on ruling out alternative diagnoses, especially A. phagocytophila, and B. microti, both of which are also transmitted by Ixodes dammini, and can cause hematologic manifestations. In our patient, these and other V. Babu S. Sukumarannair Z. Saul Bridgeport Hospital/Yale University Internal Medicine Residency Program, Bridgeport, CT, USA

Acute Q Fever Presenting as Fever of Unknown Origin with Rapidly Progressive Hepatic Failure in a Patient with Alcoholism

We report a case of fulminant acute Q fever presenting as fever of unknown origin with rapidly progressive hepatic failure in a patient with alcoholism. A 51-year-old electrician, who was a habitual drinker, presented with a 2-week history of intermittent high fever, acute hepatomegaly and rapidly progressive jaundice after being accidentally exposed to dust from bird nests when he was repairing electrical equipment and circuitry at an abandoned factory in Taipei County. Ascites and prolonged prothrombin time were noted at admission. Transjugular liver biopsy and bone marrow biopsy found multiple small fibrinoid-ring granulomas in liver parenchyma and bone marrow. Doxycycline therapy was empirically started. The fever gradually subsided over a 2-week period, along with the recovery of liver function. The diagnosis of acute Q fever was confirmed by high titers of antibodies against Coxiella burnetii (phase I IgM 1:160 and IgG 1:2560, phase II IgM > 1:320 and IgG 1:5120) and a four-fold elevation of phase II IgG titer in the paired serum. The experience of this case shows that the possibility of Q fever should not be overlooked in patients who have an unexplained febrile illness and severe liver function impairment following exposure to a contaminated environment in Taiwan.

Hemophagocytic Syndrome in Miliary Tuberculosis Presenting with Noncaseating Granulomas in Bone Marrow and Liver

Tuberculosis is a common infection in Taiwan, and it is probably a cause of reactive hemophagocytic syndrome. We report the case of a 63-year-old man with initial presentation of fever and progressive jaundice. Hemophagocytic syndrome was documented by the findings of peripheral blood smear and bone marrow biopsy. Although chemotherapy and antituberculous therapy were administered early, he passed away. Sputum and bone marrow cultures confirmed the presence of Mycobacterium tuberculosis 3 weeks later. Bone marrow biopsy revealed noncaseating granuloma. Patients with hemophagocytic syndrome should be rigorously screened for tuberculosis and antituberculous therapy should be initiated early to improve prognosis.

Fever of unknown origin and isolated noncaseating granuloma of the marrow: Could this be sarcoidosis?

Fever of unknown origin (FUO) is both a clinical and a diagnostic challenge. Furthermore, an FUO case with isolated marrow noncaseating granuloma can further confound diagnosis. However, these two findings together may help narrow down the pathological possibilities. This article presents a case report of FUO and lymphopenia for 2 months. Multiple studies to evaluate infectious etiology were unremarkable. Bone marrow biopsy revealed isolated bone marrow granuloma, suggestive of sarcoid. The patient responded well to glucocorticosteroids with resolution of lymphopenia. Sarcoid should enter the differential of lymphopenia and FUO even without lymphadenopathy or abnormal chest radiography. This article provides a of review of CD4 lymphopenia, noncaseating granuloma of the marrow, and sarcoidosis.

Amiodarone-Associated Bone Marrow Granulomas: A Report of 2 Cases and Review of the Literature

Amiodarone therapy is associated with several adverse effects, including hematologic ones such as pancytopenia, hemolytic anemia, and aplastic anemia. Very few cases of amiodarone-associated bone marrow granulomas have been reported. We report 2 cases of amiodarone-associated bone marrow granulomas. Patient 1 was an 81-year-old man who presented with leukopenia, thrombocytopenia, and hepatosplenomegaly after 2 years of amiodarone therapy. Patient 2 was an 80-year-old man who presented with pancytopenia 2 1/2 years after starting amiodarone treatment. Both patients had normal blood counts before amiodarone therapy. Bone marrow biopsies showed noncaseating granulomas in both patients. We reviewed the literature available on Medline for amiodarone-associated bone marrow granulomas and found 8 reported cases of amiodarone-associated bone marrow granulomas. One case also featured amiodarone-associated hepatic granulomas. Amiodarone therapy was stopped in 5 cases, with improvement of the granulomas occurring in 3 cases. We conclude that bone marrow granulomas, although rare, should be considered as a differential diagnosis for patients undergoing amiodarone therapy and presenting with cytopenias.

Disseminated Mycobacterium kansasii infection in an HIV-negative patient presenting with mimicking multiple bone metastases

We report a patient with disseminated Mycobacterium kansasii infection, but with no underlying disease, presenting with mimicking multiple bone metastases with cancer of unknown primary site. Disseminated M. kansasii infection is rare in HIV-negative patients without underlying diseases. This patient had disseminated M. kansasii infection manifested with vertebral osteomyelitis, sacroiliitis, psoas abscess, bone marrow granuloma, liver granuloma, and possible spleen abscesses. The clinical manifestations are described and discussed in details.

Amiodarone- Induced Bone Marrow Granulomas.

INTRODUCTION: Amiodarone is associated with several adverse effects, including hematologic side effects such as pancytopenia, hemolytic anemia and aplastic anemia. Very few cases of amiodarone-induced bone marrow granulomas have been reported.METHODS: We report 2 cases of amiodarone-induced bone marrow granulomas. Patient 1: 81-year-old male presented with leukopenia, thrombocytopenia, and hepatosplenomegaly after 2 years of amiodarone. Patient 2: 80-year-old male presented with pancytopenia 2 ½ years after starting amiodarone. Examination was unrmarkable. Bone marrow biopsies on both patients showed non-caseating granulomas with negative stains for acid-fast bacilli and fungi. Both had normal CBC before amiodarone therapy. The literature was reviewed for amiodarone-induced bone marrow granulomas on MEDLINE.RESULTS: There are 8 cases of amiodarone-induced bone marrow granulomas in the literature. Male: female - 5:3. One also had amiodarone-induced hepatic granulomas. Amiodarone was stopped in 5 cases with the improvement of granulomas in 3 cases. Patient characteristics and outcomes are shown below.RefAge/SexCBC/Chemistry abnormalitiesAssociated blood disordersAmiodarone stoppedoutcome/NoteBoutros et al67MnoneMGUSYesfewer granulomas in bone marrowBoutros et al77Fplatelet ↓noneYesplatelet count normalized and fewer granulomas in bone marrowRosenbaum et al53/FWBC ↑, Platelet ↑myelofibrosisNoalso has amiodarone-induced hypothyroidismRosenbaum et al78/FRBC ↓YesDoing well. CBC unknownMukhopadhyay et al81/MRBC ↓MDSNoErythropoetin improved anemiaMukhopadhyay et al62/MpancytopenianoneNoAlso has splenomegaly. CBC stableYamreudeewong et al63/MUnknownnoneYesBone marrow biopsy performed for fever of unknown origin. Symptoms improved.Moran et al76/MRBC ↓, LFT ↑MGUSYesBone marrow granulomas resolved. Liver biopsy showed granulomas.Our patient 181/MWBC ↓, Platelet ↓noneYesAlso has amiodarone-induced hyperthyroidism. Hepatosplenomegaly and CBC stableOur Patient 280/MPancytopenianoneNoErythropoetin improved anemiaCONCLUSION: Bone marrow granulomas, although rare, should be considered as a differential diagnosis in patients on amiodarone presenting with cytopenias.

Granulomatous reactions cause symptoms or clinically imitate treatment resistance in small lymphocytic lymphoma/chronic lymphocytic leukaemia more frequently than in other non-Hodgkin lymphomas

Aims: The electronic database of the institute of pathology, Medical University of Innsbruck, was reviewed and patient histories studied to analyse systematically the coincidence of granulomatous reactions and lymphomas in...

Amiodarone-induced bone marrow granulomas

We describe a case of a 76-year-old man with indolent myeloma who developed extensive bone marrow granulomas whilst on amiodarone therapy. The granulomas resolved on cessation of amiodarone.

Amiodarone-induced bone marrow granulomas

Amiodarone hydrochloride, a class III antiarrhythmic agent used to treat supraventricular and ventricular cardiac dysrhythmias. In this report we describe two patients receiving amiodarone for atrial fibrillation who underwent bone marrow biopsies to investigate paraproteinaemia (case 1) or severe thrombocytopenia (case 2). Multiple bone marrow granulomas were found in both patients, without evidence of any other cause. In both patients the granulomas disappeared after amiodarone withdrawal, suggesting a direct association.

Hematological manifestation of human brucellosis

Abstract Objectives and methods: In Jordan no data have been reported on the frequency and diversity of hematological abnormalities occurring in brucellosis in adults. In order to determine the hematological changes during the active course of the disease, 217 adult patients, (ages ranging from l4 to 75 years; mean 28.7 years) were studied Prospectively at the Jordan University Hospital during the Period 1987-1996. Two hundred and eleven patients who had a clinical picture suggestive of human brucellosis were admitted to the hospital for investigations. Results: From 175 cases proved to have brucellosis, anemia was detected in 76 (43.4%) patients; leukopenia in (15.4%)patients; lymphocytosis in 87 (49.7%) patients and lymphopenia in 27 (15.4%)patients. Thrombocytopenia was found in 13 (7.4 %) and pancytopenia inl2 (6.9 %) Patients. Patients with a brucella antibody titre (1280 were found to be more likely to develop bone marrow granulomata. Hypersplenism and hemophagocytosis appeared to play a role in producing these abnormalities of the peripheral blood. There was no significant relation between bone marrow granuloma and the above hematological abnormalities. Conclusion: Brucellosis may be included in the differential diagnosis of patients presenting with anemia, leukopenia, thrombocytopenia and pancytopenia especially in areas such as Jordan where the disease is endemic.