Pancytopenia in Pediatric Tuberculosis – A Case Series and Literature Review from North India

Abstract Background: Pediatric tuberculosis (TB) remains a major public health challenge in India, where malnutrition and immune immaturity increase vulnerability. While anemia and isolated cytopenias are frequent hematological manifestations, pancytopenia is rare and often mimics hematological malignancies or syndromes, delaying diagnosis. This case series from North India highlights clinical diversity, diagnostic challenges, and therapeutic outcomes of TB-associated pancytopenia. Objectives: To describe the clinical spectrum, hematological findings, diagnostic pitfalls, and treatment responses in children with pancytopenia due to disseminated TB, supported by a literature review. Methods: Five children who presenting with fever, pallor, constitutional symptoms, and hepatosplenomegaly and Pancytopenia from Jan to July 2025 in pediatric IPD were evaluated. Investigations included blood counts, micronutrient assays, bone marrow studies, imaging, and microbiological confirmation by GeneXpert/AFB. All received first-line anti-tubercular therapy (ATT) with nutritional and supportive care; one child required corticosteroids for hemophagocytic lymphohistiocytosis (HLH). Outcomes were monitored for 3–6 months. Results: All patients had disseminated or extrapulmonary TB with pancytopenia: Case 1: Bone marrow granulomas with hematological recovery after ATT. Case 2: Splenic lesions and vitamin B12 deficiency improved with ATT and supplementation. Case 3: TB-associated HLH responded to ATT with steroids. Case 4: Severe malnutrition with abdominal TB showed recovery after ATT and nutritional therapy. All children recovered clinically and hematologically within 3–6 months of treatment. Discussion: Pancytopenia in TB may result from marrow infiltration, hypersplenism, nutritional deficiencies, or immune dysregulation. Recognition is critical to avoid misdiagnosis as leukemia or aplastic anemia. Literature supports timely ATT with correction of nutritional deficiencies and, in selected cases, adjunctive immunomodulation. Conclusion: Pancytopenia, though uncommon, may signify disseminated pediatric TB. Early diagnosis, comprehensive evaluation, and prompt therapy ensure favorable outcomes in endemic settings. Keywords: Bone marrow, Disseminated TB, Pediatric tuberculosis, Pancytopenia, HLH.