Hemophagocytosis and miliary tuberculosis in a patient in the intensive care unit

We report a 60-year-old woman who was admitted to our hospital with high-grade fever and dyspnea. Laboratory findings showed pancytopenia and examination of aspirated bone marrow showed mature histiocytes with marked hemophagocytosis. The patient's condition continued to deteriorate despite adequate antibiotic coverage. Her respiratory condition worsened, so she was transferred to the ICU and ventilated. Transbroncheal biopsy was performed, which showed caseating granuloma suggesting pulmonary TB. Eight weeks later, bone marrow culture in Lowenstein media confirmed the presence of mycobacterium tuberculosis susceptible to INH, Rifampcine, pyrasinamide, ethambutol and streptomycin. Though anti-tuberculous therapy was started, she died after 28 days of hospitalization.