{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T22:27:24Z","timestamp":1773786444796,"version":"3.50.1"},"reference-count":23,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,2,17]]},"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:p>Tuberculosis (TB) is one of the greatest masqueraders in medical practice and can have manifestations involving any organ or organ systems of the body. The presentation of disseminated TB can range from typical features like fever, weight loss and fatigue to protean manifestations. We share the case of an elderly man who presented to us with weight loss, anaemia, weakness and lymphadenopathy involving thoracic and intraabdominal locations. Work up of anaemia revealed features of Coombs-positive autoimmune haemolytic anaemia (AIHA) and evaluation of weakness showed laboratory results consistent with adrenal insufficiency. Biopsy of the abdominal lymphnode yielded caseating granulomas with CB-NAAT positivity for <jats:italic>Mycobacterium tuberculosis<\/jats:italic>. Anti-TB chemotherapy with short-term replacement dose of systemic steroids corrected the haemolysis, anaemia and addisonian crisis. The case alerts clinicians regarding the uncommon association of TB with Coombs positive AIHA and adds one more aetiology to the pathogenesis of anaemia in TB. Furthermore, the occurrence of AIHA and hypoadrenalism in the same patient with TB is exceedingly rare and has not been reported.<\/jats:p>","DOI":"10.1136\/bcr-2022-249277","type":"journal-article","created":{"date-parts":[[2022,3,4]],"date-time":"2022-03-04T11:26:45Z","timestamp":1646393205000},"page":"e249277","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Disseminated tuberculosis associated with autoimmune haemolytic anaemia and adrenal deficiency: a rare association"],"prefix":"10.1136","volume":"15","author":[{"given":"Rajesh","family":"Venkitakrishnan","sequence":"first","affiliation":[{"name":"Pulmonary Medicine, Rajagiri Hospital, Aluva, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jolsana","family":"Augustine","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, Rajagiri Hospital, Aluva, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0086-1615","authenticated-orcid":false,"given":"Mobin","family":"Paul","sequence":"additional","affiliation":[{"name":"Clinical Hematology, Rajagiri Hospital, Aluva, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Latha","family":"Abraham","sequence":"additional","affiliation":[{"name":"Department of Pathology, Rajagiri Hospital, Aluva, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,3,4]]},"reference":[{"key":"2025082800141505000_15.3.e249277.1","doi-asserted-by":"crossref","first-page":"164","DOI":"10.4103\/1658-5127.146953","article-title":"Tuberculosis and autoimmune hemolytic anemia: case report and literature review","volume":"5","author":"Bahbahani","year":"2014","journal-title":"J Appl Hematol"},{"key":"2025082800141505000_15.3.e249277.2","doi-asserted-by":"crossref","DOI":"10.1155\/2013\/353798","article-title":"Unusual manifestation of extrapulmonary tuberculosis","volume":"2013","author":"Alghamdi","year":"2013","journal-title":"Case Rep Med"},{"key":"2025082800141505000_15.3.e249277.3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/ijmy.ijmy_4_21","article-title":"A systematic review of adrenal insufficiency among patients with pulmonary tuberculosis in sub-Saharan Africa","volume":"10","author":"Azeez","year":"2021","journal-title":"Int J Mycobacteriol"},{"key":"2025082800141505000_15.3.e249277.4","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(90)90340-J"},{"key":"2025082800141505000_15.3.e249277.5","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1097\/MED.0b013e328338f608","article-title":"Adrenal insufficiency: etiology, diagnosis and treatment","volume":"17","author":"Neary","year":"2010","journal-title":"CurrOpin Endocrinol Diabetes Obes"},{"key":"2025082800141505000_15.3.e249277.6","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1111\/j.1365-2141.1973.tb01791.x","article-title":"Tuberculosis and blood disorders","volume":"25","author":"Coburn","year":"1973","journal-title":"Br J Haematol"},{"key":"2025082800141505000_15.3.e249277.7","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13223-018-0236-y","article-title":"Tuberculosis induced autoimmune haemolytic anaemia: a systematic review to find out common clinical presentations, investigation findings and the treatment options","volume":"14","author":"Rathish","year":"2018","journal-title":"Allergy Asthma Clin Immunol"},{"key":"2025082800141505000_15.3.e249277.8","doi-asserted-by":"publisher","DOI":"10.1016\/0041-3879(74)90067-1"},{"key":"2025082800141505000_15.3.e249277.9","doi-asserted-by":"publisher","DOI":"10.1378\/chest.119.6.1961"},{"key":"2025082800141505000_15.3.e249277.10","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.rmedc.2008.05.002","article-title":"Autoimmune bicytopenia in pulmonary tuberculosis. 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