Miliary tuberculosis is commonly associated with various hematologic changes
including anemia, leukopenia, leukocytosis, monocytosis, leukemoid reaction, basophilia,
disseminated intravascular coagulation, and rarely pancytopenia. Pancytopenia in miliary
tuberculosis has been proven a grave prognostic indicator. The precise mechanism of
pancytopenia in miliary tuberculosis is not known yet and there are still much
controversy. Recently, reactive histiocytic hemophagocytic syndrome was accepted as one
of possible mechanisms of pancytopenia accompanied with miliary tuberculosis
Authors experienced a rare case of pancytopenia and hemophagocytic syndrome
associated with miliary tuberculosis in a 69-year-old female. The bone marrow
examination revealed osseous granulomas with tuberculous bacilli and histiocytic
hemophagocytosis. Despite anti-tuberculosis chemotherapy and active supportive care, the
pancytopenia did not resolved, finally she died of respiratory failure.
Tuberculosis is a common infection in Korea. Therefore, in the presence of
pancytopenia, together with pyrexia and hepatopathy, miliary tuberculosis should always
be considered.

Keywords: Miliary tuberculosis, Pancytopenia, Reactive histiocytic hemophagocytic syndrome