Described here a patient of pure red cell aplasia in patient with pulmonary tuberculosis. The patient was 64 year-old man who entered the Severance Hospital with dizziness and general weakness for 1 year. Four years prior to admission, he was treated with anti-tuberculous agents for 1 year due to tuberculous meningitis. One year before admission, he was taken cholecystectomy and resection of lipoma at right anterior chest wall. Then he was moderately anemic. Thereafter he had been transfused 1-2 pints of whole blood monthly because of uncontrolled anemia.
On physical examination, there were no specific findings except moderate pallor and weak state. Peripheral blood examination revealed normochromic norinocytic anemia with normal leukocytes and plateletes. Hematocrit was 23% and RBC counts was 3 million/mm3. Leukocyte count was 11, 300/ mm3 with normal differentiation and platelet 274, 000/mm3. Reticulocyte counts was less than 0.3%. Serum iron was 214 pg and UIBC 347 μg per 100 ml. RBC fragility test was normal (0.48%~0.34%). The aspiration of the bone marrow disclosed a normocellular marrow with normal maturation. The differential count of nucleated cells in the marrow showed; myeloblast 4.0%, promyelocyte 6.9%, neutrophilic myelocyte 19.3%, eosinophilic myelocyte 3.2%, meta-myelocyte 18.7%, band form 21.8%, segmented neutrophil 6.0%, eosinophil 3.2%, lymphocyte 12.2%, plasma cell 0.1%, reticulum cell 3.7%, erythroid element 0.5% and megakaryocytes adequate.
Chest film showed soft parenchymal and peribronchial infiltration with a probable cavity at right lower lung field. There was no evidence of thy moma. Mycobacterium tuberculosis was grown on the culture of sputum for 7 weeks.
He was treated with anti-tuberculous agents, androgens and blood transfusions without benefit.
It couldn´t be concluded whether the pure red cell aplasia in this case was resulted from antituberculous agents and/or pulmonary tuberculosis, or not. But it might be possible that the pulmonary tuberculosis was incidental and the p re rod cell aplasia was idiopathic in this case.
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