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Mycobacterium tuberculosis of bone marrow that is considered one of the rare extrapulmonary tuberculosis (TB). Herein we report one case of tuberculosis of the bone marrow. A 82-year-old Thai woman presented with fever, fatigue, and weight loss of 4 kg in one month. The physical examination revealed only pallor and the ejection murmur at the upper parasternal border. Her chest film was unremarkable but the computed tomography of the chest revealed the reticular infiltration at both lower lungs and multiple small mediastinal lymphadenopathies. Although her blood smear did not show the leukoerythroblastic blood picture with the tear drop red blood cells (RBCs) or pancytopenia, her bone marrow biopsy showed a few granulomas with positive acid fast bacilli (AFB). The common risk factors such as diabetes, human immunodeficiency virus (HIV) infection, low CD4 counts, chronic kidney disease, malnutrition, and immunosuppressant therapy which might contribute her to be vulnerable to TB, were not found. The definite diagnosis was TB in the bone marrow and she clinically responded well to the 4-drug antituberculous regimen. Our case suggests that even though the leukoerythroblastosis with the tear drop RBCs or pancytopenia, the clues of the bone marrow involvement, is not found, the study of the bone marrow should not be precluded from the plan of the investigations for the diagnosis in a case of fever of unknown origin.
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