Case presentation A 59-year-old male presented with a 2-week history of fever, rigors, fine maculopapular rash, and weakness. He also had ulcerating papule on his left forearm. Examination Persistent fever Fine maculopapular rash Pancytopenia Hepatomegaly Pneumonitis Eschar Investigation Hemoglobin – 10.3 mg/dL Neut – 1.45/mL blood Lymph – 0.59 X10 9 /L Fibrinogen – 4 g/L CRP – 217 mg/L Bone marrow biopsy Hypercellular marrow Poorly formed granulomas (AFB negative) Infiltration of plasma cells and histiocytes (CD68 pos) Evidence of hemophagocytosis (of granulocyte and erythroid precursors) Bronchoscopy and BAL brushings AFB positive PCR positive for MTB, sensitive to rifampicin and INH TB culture was positive after 19 days.
(TB culture of initial sputum was positive after 32 days) What is your most likely diagnosis for this patient? *This Case Challenge is from the Editorial Team of…
