Bone Marrow Tuberculosis (TBM): Causes, Symptoms & Treatment

Bone marrow tuberculosis (TBM) is a rare form of disseminated TB where M. tuberculosis infects the marrow. It occurs in immunocompromised hosts (HIV, diabetes, malignancy) or as part of miliary TB.

Clinical Features

• Fever, night sweats, weight loss, fatigue (constitutional).
• Bone/joint pain (often axial skeleton).
• Cytopenias (anemia, thrombocytopenia, leukopenia) from marrow infiltration/suppression.
• Hepatosplenomegaly, lymphadenopathy.

Diagnosis

Bone marrow aspirate/biopsy: AFB stain, culture, PCR, histopathology (caseating granulomas). Blood cultures, imaging (MRI, PET‑CT) assess extent.

Treatment

Standard anti‑TB regimen (2HRZE/4HR) ± corticosteroids for severe inflammation. Duration may extend to 9–12 months for disseminated disease. Surgery rarely needed (decompression, debridement). Monitor for drug toxicity, immune reconstitution inflammatory syndrome (IRIS) in HIV.

Early diagnosis and treatment prevent irreversible marrow failure, sepsis, and death.