SHM Converge Scientific Abstract ePoster Gallery-Bone Marrow Sarcoidosis Complicated by Mycobacterium Haemophilum Infection

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This case report describes a 63-year-old man with a history of type 2 diabetes, atrial fibrillation, ESRD on hemodialysis, and AML in remission after allogeneic stem cell transplant who was admitted with weakness and confusion. He developed pancytopenia, and bone marrow biopsy revealed scattered non-caseating granulomas, initially suggesting sarcoidosis. Supporting labs and imaging did not indicate AML recurrence, so he was discharged on prednisone with presumed sarcoidosis.

However, a few weeks later, the bone marrow culture grew <strong>Mycobacterium haemophilum</strong>, showing that the granulomatous marrow disease and pancytopenia were actually due to an opportunistic infection rather than sarcoidosis. His steroid therapy was tapered, vitamin D stopped, and he was treated with azithromycin, ethambutol, and rifabutin, later adjusted to ciprofloxacin based on sensitivities. The case was also reviewed by experts at National Jewish, who agreed with the management plan.

The report emphasizes that non-caseating granulomas are not specific for sarcoidosis and that infection must be excluded, especially in immunocompromised patients. In this patient, prior stem cell transplant, ongoing immunosuppression, and ESRD likely created conditions that allowed <strong>M. haemophilum</strong> to infect the bone marrow. The case highlights the importance of repeating biopsy and obtaining cultures when the first sample is insufficient, as well as maintaining a broad differential diagnosis for granulomatous inflammation and cytopenias in patients with a history of hematologic malignancy.

Asset Subtitle

Philisha Mesidor

Meta Tag

Author List Antoni Wojtkowski, Helina Feleke, Patrick Kennedy, Philisha Mesidor

Category Clinical Vignettes

Concept Bone Marrow Sarcoidosis

Concept Mycobacterium haemophilum

Concept Noncaseating Granuloma

Concept Pancytopenia

Concept Acute Myeloid Leukemia Recurrence

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Philisha Mesidor

Track Adult

Keywords

Mycobacterium haemophilum

non-caseating granulomas

sarcoidosis

bone marrow biopsy

pancytopenia

immunocompromised host

allogeneic stem cell transplant

hematologic malignancy

opportunistic infection

ESRD hemodialysis

Bone Marrow Sarcoidosis

Mycobacterium haemophilum

Noncaseating Granuloma

Pancytopenia

Acute Myeloid Leukemia Recurrence