CASE PRESENTATION: A 54 year old man had repeated fever, chronic cough, sweating and general pain for over 20 days. He had a history of pulmonary tuberculosis a year ago, and ceased the drug therapy after a month. He had no underlying debilitating disorders. The patient had a fever of 38.5°C, with a left supraclavicular lymph node enlargement (1.0 cm in diameter) and a sternal tenderness. Routine blood tests showed severe anemia repeatedly (HGB:50-60g/L). Marrow cytology showed anemia and nucleated cell proliferation activity and obviously increased neutrophils ratio (about 78%). BM biopsy sections showed myelofibrosis. Diffuse miliary nodules in both lung and multiple lymphadenopathies in hilar lymphatic nodules were detected on Chest CT. Other examinations were negative. We gave the patient a combination therapy of isoniazid, rifampicin, pyrazinamide, and ethambutol. 10 days later, the patient’s imaging changes had improved, with resolution of general pain, fever and cough. About 4 months later, his bone marrow biopsy did not showed myelofibrosis anymore.