The coexistence of peripheral neuropathy and chronic tubulointerstitial nephritis in a patient can be secondary to various diseases including—connective tissue disorders, sarcoidosis, IgG4-related ...disease, heavy metal poisoning, plasma cell dyscrasias, and drugs. A 70-year old woman was admitted with fatigue for 4 months and numbness of both lower limbs for 6 months. She had antral gastritis and was on treatment with pantoprazole for 1 year. On evaluation, she had peripheral neuropathy and chronic tubulointerstitial nephritis which was suspected to be secondary to pantoprazole after ruling out other causes. We present a patient with multiple complications (peripheral neuropathy and chronic tubulointerstitial nephritis) likely associated with pantoprazole which was not reported in the literature previously to the best of our knowledge.
A 68-year-old man presented with a low-grade fever for one month. He had loss of appetite and had lost 6 kilograms of weight in the last two months. He was evaluated and found to have miliary ...tuberculosis with pancytopenia. The bone marrow revealed Gelatinous transformation of bone marrow and there was no evidence of other causes of pancytopenia like histiocytic hyperplasia, maturation arrest, or infiltration of the bone marrow. The pancytopenia improved with anti-tubercular treatment showing the reversible nature of the disease. To conclude, multiple mechanisms can result in pancytopenia in tuberculosis. A bone marrow study can reveal most of them including rare causes like GTBM.
A 55-year-old homemaker presented with low-grade fever, fatigue, and loss of weight for 2 months. She had hepatosplenomegaly, mediastinal lymphadenopathy, cytopenias, hypercalcemia with normal ...parathormone, and noncaseating granulomas in bone marrow and lymph node biopsy. The patient was diagnosed to have sarcoidosis with bone marrow involvement (histopathology showing noncaseating granuloma and high serum angiotensin-converting enzyme after ruling out other causes of granulomatous disorders by appropriate tests). She was managed with prednisolone 20 mg daily which was reduced and stopped after 3 months. On follow-up, she was asymptomatic and her blood counts were normal. Diagnosis of sarcoidosis should be considered always after ruling out other causes since it can mimic lymphoproliferative disorders and granulomatous infections. The initial presentation of sarcoidosis with bicytopenia due to bone marrow granulomas is extremely rare and physicians should have awareness of such atypical presentations.
