A RARE PRESENTATION OF COLD AGGLUTININ DISEASE SECONDARY TO REACTIVATED PULMONARY TUBERCULOSIS IN A YOUNG ADULT MALE

Cold Agglutinin Disease (CAD) is a form of autoimmune haemolytic anaemia (AIHA) typically associated with infections or lymphoproliferative disorders. While Mycoplasma pneumoniae is a well-known trigger, its association with Mycobacterium tuberculosis is rarely documented. We present a case of a 20-year-old male with a history of TB and prior AIHA who presented with severe haemolytic anaemia (Hg- 2.5 g/dL) and was found to have reactivated pulmonary tuberculosis and CAD. The management was complicated by the contraindication of corticosteroids due to active TB, necessitating stabilization via blood transfusions and initiation of anti-tubercular therapy (ATT). This case highlights the diagnostic challenge of differentiating primary and secondary AIHA in the presence of chronic infection.