Pregnancy in a patient with myelofibrosis secondary to ileocecal tuberculosis: a case report

Abstract

Myelofibrosis (MF) is a chronic myeloproliferative neoplasm that may occur de novo or secondarily due to infections, autoimmune disorders, or malignancies. Tuberculosis (TB)-induced MF is uncommon but clinically relevant in TB-endemic regions, as it represents a reversible, non-clonal process that can mimic primary MF and lead to unnecessary cytotoxic therapy if not correctly identified. We report the case of a 24-year-old woman who initially presented with pancytopenia, splenomegaly, and constitutional symptoms. Bone marrow examination revealed grade 2 fibrosis, and further evaluation indicated ileocecal TB, leading to a diagnosis of secondary MF due to TB. She was initiated on anti-tubercular therapy (ATT), resulting in significant clinical and hematologic improvement. The patient subsequently conceived spontaneously and later presented at 36 weeks of gestation with mild anemia, severe thrombocytopenia, and a history of allergic reactions to platelet transfusions. When she was admitted at term with critically low platelet counts necessitating transfusion, perioperative management became particularly challenging and required a coordinated multidisciplinary approach involving hematology, transfusion medicine, obstetrics, neonatology, and critical care. Her pregnancy was managed with strict antenatal, intraoperative, and postpartum monitoring. She remained clinically stable and did not require cytotoxic or disease-modifying therapy, and both maternal and neonatal outcomes were favorable. This case highlights the importance of differentiating reactive MF from clonal myeloproliferative neoplasms, especially in TB-endemic settings. TB-induced MF is reversible with appropriate antimicrobial therapy, and successful pregnancy outcomes are achievable with individualized, coordinated obstetric and hematological care. Diagnostic vigilance is essential to avoid overtreatment and to ensure optimal outcomes for women of reproductive age presenting with marrow fibrosis secondary to TB.