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Direct antibody test negative autoimmune hemolytic anemia with pulmonary tuberculosis: A diagnostic challenge
Agarwal Sheetal1, Singh Ruby2, P Singh Dhirendra2, Gupta Anubhav3, Nandan Devki1
1 Department of Pediatrics, Division of Pediatric Pulmonology and Intensive Care, ABVIMS and Dr. RML Hospital, New Delhi, India
2 Department of Pediatrics, ABVIMS and Dr. RML Hospital, New Delhi, India
3 Department of Transfusion Medicine, ABVIMS and Dr. RML Hospital, New Delhi, India
Correspondence Address:
Nandan Devki,
Department of Pediatrics, Division of Pediatric Pulmonology and Intensive Care, ABVIMS and Dr. RML Hospital, New Delhi
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/ajts.AJTS_75_20
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Tuberculosis (TB) has varied manifestations, but autoimmune hemolytic anemia (AIHA) due to TB is rare. Direct antibody test (DAT) or Coombs negative AIHA is also rare. We report a case of a 14-year-old boy who presented with hemolytic anemia and pneumonia. The Coombs test was repeatedly negative. After ruling out the possible infectious and noninfectious causes by extensive investigations, he was diagnosed as DAT-negative AIHA by monospecific antibody test with 4°C low ionic strength saline washes and column agglutination method which revealed the presence of IgG-2+ antibodies. Bronchoalveolar lavage fluid for acid-fast bacilli and gene Xpert was also positive. It is important to recognize TB as a cause of AIHA in South Asian countries where its incidence is high.
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