Hematological manifestations of undiagnosed tuberculosis: a report of two rare cases

Background. Tuberculosis (TB) is a prevalent infectious disease with diverse clinical manifestations. Hematological abnormalities, though uncommon, can present as primary features of TB, complicating its diagnosis and management. These atypical presentations often mimic hematological malignancies, posing diagnostic challenges, particularly in endemic regions. Case report. This report discusses two rare cases of disseminated TB with distinct hematological presentations. The first case involved a 57-year-old male with autoimmune hemolytic anemia (AIHA), characterized by intravascular hemolysis confirmed by a positive Coombs test, elevated LDH, and hyperbilirubinemia. The second case featured a 42-year-old female with hypersplenism due to massive splenic involvement in miliary TB, leading to extravascular hemolysis and pancytopenia. Both patients responded well to anti-tubercular therapy (ATT), with adjunctive corticosteroids required in the first case. Conclusions. These cases highlight the protean hematological manifestations of disseminated TB and emphasize the importance of considering TB in the differential diagnosis of unexplained hematological abnormalities. Early recognition, comprehensive evaluation, and timely initiation of ATT are critical for favorable outcomes.