TUBERCULOSIS, MYCOBACTERIA INFECTION AND HAIRY-CELL LEUKEMIA

OBJECTIVES: Diagnosis of tuberculosis and/or mycobacteria infection is particularly difficult in immunocompromised patients. PATIENTS AND ME THODS: We examined the clinical pre sentation, means of diagnosis, tre atment and outcome of tuberculosis in a retrospective study of 6 patie nts among 75 with hairy cell leukemia diagnosed from 1982 to 1995. RES ULTS: Hearlding symptoms of tuberculosis diagnosis were: fever (6/6), weight loss (4/6), pleural effusion (1/6), superficial adenopathy (1/6 ), persistance of cytopenia or splenomegaly during the treatment of ha iry cell leukemia. Pulmonary symptoms were present in only two cases. Diagnosis was obtained by positive culture of mycobacteria in 2 cases (Mycobacterium tubercuiosis in pleural effusion, Mycobacterium kansaii in adenopathy). Microbiological diagnosis was never obtained from spu tum (6/6). Diagnosis was obtained by histopathology in all cases: from bone marrow (2 cases), lymph nodes (2 cases), liver(1 case), spleen ( 1 case), umbilical fat(1 case). Tuberculosis was disseminated in all c ases. By clinical, biological, microbiological histopathological means and response to treat ment, tuberculosis was considered red as: hemat opoietic in all cases, hepatic (in 4/6), pleural (1/6), pulmonary (1/6 ). A favorable outcome of tuberculosis was observed in all cases. No d eath was observed. CONCLUSION: Tuberculosis was found in 8% of hair ce ll leukemia patients. In hairy cell leukemia, tuberculosis is charac t erized by few pulmonary symptoms and scarse microbiological documentat ion. In contrast, histopathology is very interesting to confirm diagno sis. Tuberculosis is in most cases disseminated and in particular hema topoietic diffusions is always present in spite of existensive localiz ation, the prognosis remains excellent and all patients can be cured. In our opinion, this good prognosis may be linked to the improve ment of hairy cell leukemia treatment observed since the advent of interfer on pentostatin and 2cdA. (C) 1997, Masson, Paris.