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A unique case of tuberculosis dissemination presenting as cutaneous lesions in a post allogeneic stem cell transplant patient

Bone Marrow Transplantation volume 51, pages 1385–1386 (2016)Cite this article

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A 50-year-old woman was admitted to hospital due to fevers, dyspnea and hematuria. She was in second remission at 3 months post allogeneic stem cell transplant for AML from a matched unrelated donor. Her conditioning regimen consisted of fludarabine, busulfan and 400 cGy total body radiation. GvHD prophylaxis consisted of antithymocyte globulin, 2 doses of post-transplant cyclophosphamide and cyclosporine. She had a prior history of campath- and fludarabine-use 3 months prior to transplantation. Pretransplant comorbidities included hypertension and hepatitis B core Ab positivity. Her early post-transplant course was complicated by CMV reactivation, Hickman exit site infection by Staphylococcus aureus, drug-induced pancytopenia and BK-virus-associated hemorrhagic cystitis.

She presented to the outpatient clinic with fatigue and fevers up to 38 °C with macroscopic hematuria with evidence of clots. Cardiac, respiratory and abdominal exams were unremarkable. She was admitted for further management of her hematuria and workup of fevers, and was empirically started on antibiotics and antifungal agents. Computed tomography of the chest was done for respiratory distress 6 days later, which revealed small bilateral pleural effusions and left upper lobe peribronchovascular consolidation with mediastinal and hilar lymphadenopathy. Similar adenopathy was evident on abdominal scanning. Diagnostic bronchoscopy performed for microbiological cultures was negative, including mycobacterial cultures.

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Authors and Affiliations

  1. Department of Medical Oncology and Hematology, Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada

    W Lam, A Viswabandya, H A Messner, F V Michelis, D D Kim, J H Lipton & U Deotare

  2. Division of Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada

    S Hussain

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  1. W Lam
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  2. A Viswabandya
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  3. S Hussain
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  4. H A Messner
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  5. F V Michelis
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  6. D D Kim
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  7. J H Lipton
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  8. U Deotare
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Correspondence to U Deotare.

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Lam, W., Viswabandya, A., Hussain, S. et al. A unique case of tuberculosis dissemination presenting as cutaneous lesions in a post allogeneic stem cell transplant patient. Bone Marrow Transplant 51, 1385–1386 (2016). https://doi.org/10.1038/bmt.2016.137

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