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Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
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Myelofibrosis with Tuberculosis: A Case Report

YK Jin, QL Shi, CH Peng, H Yu, XY Zhang, XW Ye*

Guizhou Provincial People’s hospital, Guiyang, China

Abstract: Myelofibrosis (MF), or fibrosis of the bone marrow, is an uncommon condition. Most cases arise secondary to other disease processes. However, whether tuberculosis can stimulate a secondary fibrotic reaction or develop in patients who have preexisting myeloproliferative disorders is not clear. Here we present a case of a 54-year-old man whose myelofibrosis disappeared completely after administration of antituberculous treatment. The purpose of reporting this case is to reconsider the relationship between tuberculosis and secondary myelofibrosis.

Keywords: myelofibrosis, tuberculosis

Citation: YK Jin, QL Shi, CH Peng, H Yu, XY Zhang, XW Ye, Myelofibrosis with Tuberculosis: A Case Report. American Journal of Medical Case Reports, 4 (7). 240-241. January 2016. doi:10.12691/ajmcr-4-7-6

1. Case Report

A 54 year old man came to our hospital with complaints of repeated fever, chronic cough, sweating and general pain for over 20 days. He had a history of pulmonary tuberculosis (TB) a year ago, because of the discomfort of gastrointestine, he stopped the drugs of antituberculosis himself after using only one month. He had no underlying debilitating disorders. On physical examination, the patient had a fever of 38.5°C,with a left supraclavicular lymph node enlargement, about 1.0 cm in diameter. He had a sternum tenderness. Examination of the respiratory system showed normal breath sounds without moist rales or rhonchi on both lung fields. Other systems were normal.

The chest CT showed that the distribution of the diffuse miliary nodules in both lung, enlargement of hilar lymphatic nodules. Thoracic uneven bone density, bone destruction in part. The examination of marrow cell showed anemia and nucleated cell proliferation activity, the neutrophils ratio increased obviously, about 73%. Bone marrow biopsy presented myelofibrosis. Ultrasound of heart and abdomen was negative. Both colonoscopy and gastroscope didn’t show abnormal. Head CT plain scan was negative. Several active bone metabolism in the whole body were found by skeleton ECT scan, its property was undefined. Routine blood showed severe anemia repeatedly (HGB:50-60g/L). Based on the history of tuberculosis and the examinations the patient had, anti-TB treatment was started with 2HRZE/ 6HR. With this treatment he showed a phenomenal improvement after 10 days. His general pain relieved, and fever also subsided. About 4 months later,his bone marrow biopsy did not showed myelofibrosis any more.

2. Discussion

Myelofibrosis(MF), alternatively is also known as myelosclerosis, is a rare hematologic disorder characterized by extensive fibrosis of the bone marrow. In a majority of cases, the etiology of this disease is unknown. However, many conditions such as extensive granulomatous or neoplastic involvement of the bone marrow, chronic irradiation, as well as benzene or phosphorus poisoning have been suggested as possible causes. [1] When it appears as a histological feature associated with well-characterized malignant or benign diseases of hematopoietic or non- hematopoietic origin, is considered to be a secondary disorder. Among non-hematopoietic diseases that occur concomitantly with myelofibrosis, tuberculosis is reported sufficiently frequently to raise the possibility that a relationship exists between the 2 entities. [2,3] An association between myeloproliferative disorders and tuberculosis was first postulated to exist over 70 years ago. [4] Several reports have focused on tubercular infections in patients with preexisting chronic myeloproliferative disorders associated with myelofibrosis,such as myeloid metaplasia. [5] Large autopsy studies have indicated that the frequency of tuberculosis is 2-2.5-fold higher worldwide among patients with myelofibrosis or chronic myelogenous leukemia than in the general population. [6] Recent study in vitro models showed that exposure to a mycobacterial antigen, ESAT-6, exacerbates granulomatous and fibrotic changes. [7] Verma et al found that Mycobacterium tuberculosis induced IL-1 secretion and pro-fibrotic responses by fibroblasts. [8] In a case report, present a 73-year-old man with preexisting myeloproliferative disorder, combined with tuberculosis. This combination of complications exacerbates the disease, leading rapid leukemic transformation and the patient's death. [9]

Allogeneic stem cell transplantation is the only treatment with a curative potential, but only a minority of patients are eligible for it. [10,11] Bone marrow transplantation, cord blood transplantation are curative in some cases probably. [12,13] Many asymptomatic patients, if stable, do not require treatment. Therapy is directed to manage complications and to improve quality of life. For younger patients allogeneic marrow transplantation should be considered. [11] Other therapeutic options are Corticosteroids, IV Immunoglobulins, Alfa Interferon, which may lead to resolution of ﬁbrosis and restoration of blood counts. [14] Use of Hydroxyurea, Thalidomide, alone, or in combination with Prednisolone are other options. [15] The identication of cause like Tuberculosis should prompt treatment of that disorder. Whether an interaction between tuberculosis and myelofibrosis exists was moot, the clinical history of our patient suggests that a causal relationship exists between the 2 entities, because myelofibrosis was not observed in the bone marrow biopsy section after antituberculous treatment was administered.This strongly suggests that a causal relationship did exists between tuberculosis and myelofibrosis. Physician should be aware of this association, and testing for tuberculosis should always done for patients with myelofibrosis.

References

[1]   | Sohn MH, Kim MW, Lim ST, et al. Unusual bone scintigraphic findings of secondary myelofibrosis associated with disseminated tuberculosis before and after therapy. Clinical nuclear medicine. 2004;29 (11) :706-8.
[2]   | Viallard JF, Parrens M, Boiron JM, et al. Reversible myelofibrosis induced by tuberculosis.Clin Infect Dis. 2002;34(12):1641-3.
[3]   | Sohn MH, Kim MW, Lim ST, et al. Unusual bone scintigraphic findings of secondary myelofibrosis associated with disseminated tuberculosis before and after therapy.Clin Nucl Med. 2004;29(11):706-8.
[4]   | Dyke SC. Some cases of aleukia or aplastic anaemia associated with thrombopaenia. Lancet.1924;1:1048-51.
[5]   | Dhamija RK, Chugh S, Yadav RB, et al. Myelofibrosis with myeloid metaplasia due to tuberculosis.J Assoc Physicians India. 1998;46(4):394.
[6]   | Morrow LB, Anderson RE. Active tuberculosis in leukaemia,malignant lymphoma and myelofibrosis. Arch Pathol.1965; 79(5):484-93.
[7]   | Malur A, Barna BP, Patel J, et al. Exposure to a Mycobacterial Antigen, ESAT-6, Exacerbates Granulomatous and Fibrotic Changes in a Multiwall Carbon Nanotube Model of Chronic Pulmonary Disease. J Nanomed Nanotechnol, 2015. 6(6).
[8]   | Verma SC, Agarwal P, and Krishnan MY. Primary mouse lung fibroblasts help macrophages to tackle Mycobacterium tuberculosis more efficiently and differentiate into myofibroblasts up on bacterial stimulation. Tuberculosis (Edinb), 2016. 97: p. 172-80.
[9]   | Kim SJ, Lee Y, Kim SH, et al. Extramedullary peritoneal hematopoiesis combined with tuberculosis in a patient with primary myelofibrosis. Med Oncol, 2009. 26(2): p. 238-41.
[10]   | Toivari A, Itala-Remes M, Kauppila M,et al. Stem cell transplantation in myelofibrosis. Duodecim. 2011; 127(22): 2375-82.
[11]   | Ghanima W, Knutsen H, Delabie J,et al.Primary myelofibrosis--pathogenesis, diagnosis and treatment. Tidsskr Nor Laegeforen.2013;133(18):1946-50.
[12]   | Yamamoto M, Ohashi K, Hirashima Y, Kobayashi T, Kakihana K, Akiyama H, Sakamaki H. Poor outcome of myeloablative conditioned allogeneic bone marrow transplantation for myelofibrosis. Intern Med. 2012; 51(10):1183-6.
[13]   | Robin M, Giannotti F, Deconinck E,et al. Unrelated cord blood transplantation for patients with primary or secondary myelofibrosis. Biol Blood Marrow Transplant. 2014; 20(11): 1841-6.
[14]   | Pilorget H, Bangui A, Adam M: Myelofibrosis Regressing Under Corticotherapy And Intravenous Immunoglobulins In An Infant. Arch Pediatr. 1996; 3(1): 40-3.
[15]   | Mesa RA, Elliott MA, Schroeder G, et al. Durable responses to thalidomide-based drug therapy for myeloﬁbrosis with myeloid metaplasia. Mayo Clin Proc. 2004; 79(7): 883-9.