• M Geisse, G Mall, D Fritze, and M Gartenschläger.
• Pathologisches Institut, des Klinikums Darmstadt, Germany.
• Dtsch. Med. Wochenschr. 2002 Dec 13; 127 (50): 2673-6.

History And Admission FindingsA 60-year-old man with anaemia was found to have a myelodysplastic syndrome (MDS) which was classified as refractory anemia with ringsideroblasts (RAEB). Because of severe fever the patient was hospitalized. Waldeyer's throat ring revealed signs of acute inflammation.Laboratory FindingsIndicated severe anemia and thrombocytopenia. Leucocytes were 8000/ml with a pathological shift to the left (1920/ml blasts). CRP (4.7 g/dl) and BSG (59/91mm) were abnormal. An axial CT of the neck showed a left sided paratonsillar abscess.Diagnosis And TherapyThe tonsillitis was treated with antibiotics. Persistent fever up to 39.8 degrees C suggested resistance to therapy. After three weeks the patient developed septicemia and died. Autopsy revealed MDS with excess of blasts in transformation (RAEBT-t). Granulocytic sarcoma was found in the throating where there was no paratonsillar abscess. Generalized miliary tuberculosis was proved at autopsy, explaining the continuous fever resistant to antibiotic treatment.ConclusionGranulocytic sarcoma is rarely associated with myelodysplastic syndrome. Deficiency in the immune system may facilitate the occurrence of miliary tuberculosis.

27 keywords...

hide…