Granulocytic sarcoma of the tonsils associated with myelodysplastic syndrome

History and admission findings: A 60-year-old man with anaemia was found to have a myelodysplastic syndrome (MDS) which was classified as refractory anemia with ringsideroblasts (RAEB). Because of severe fever the patient was hospitalized. Waldeyer's throat ring revealed signs of acute inflammation. Laboratory findings: indicated severe anemia and thrombocythopenia. Leucocytes were 8000/mul with a pathological shift to the left (1920/mul blasts). CRP (4.7 g/dl) and BSG (59/91 mm) were abnormal. An axial CT of the neck showed a left sided paratonsillar abscess. Diagnosis and therapy: The tonsillitis was treated with antibiotics. Persistent fever up to 39.8degreesC suggested resistance to therapy. After three weeks the patient developed septicemia and died. Autopsy revealed MDS with excess of blasts in transformation (RAEBT-t). Granulocytic sarcoma was found in the throating where there was no paratonsillar abscess. Generalized miliary tuberculosis was proved at autopsy, explaining the continuous fever resistant to antibiotic treatment. Conclusion: Granulocytic sarcoma is rarely associated with myelodysplastic syndrome. Deficiency in the immune system may facilitate the occurrence of miliary tuberculosis.