A case of tuberculosis-induced hemophagocytic lymphohistiocytosis in a patient under hemodialysis

Su, Nai-Wen; Chen, Chi‐Kuan; Chen, Gon-Shen; Hsieh, Ruey‐Kuen; Chang, Ming‐Chih

doi:10.1007/s12185-009-0265-x

Cited by 17 publications

(12 citation statements)

References 22 publications

(24 reference statements)

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“…were found in the world literature till March 2014. [ 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 ] The following data were collected for TB-HLH cases and placed in Microsoft office Excel 2007 for statistical analysis: Age, gender, duration of symptoms, associated comorbidities, organomegaly, complete blood count, serum biochemical parameters (ferritin, triglyceride, fibrinogen, liver transaminases, alkaline phosphatase, total bilirubin, albumin, and lactate dehydrogenase), coagulation abnormalities, evidence of hemophagocytosis on bone marrow evaluation, source and method of isolation of the organism, usage of ATT and/or immunosuppressive/immunomodulators drugs, and final outcome (alive or dead). Finally, complete information was available in 63 out of 70 cases, and the remaining 7 were excluded due to inaccessibility of the complete articles and/or lack of adequate information.…”

Section: Methodsmentioning

confidence: 99%

Hemophagocytic lymphohistiocytosis: An unusual complication in disseminated Mycobacterium tuberculosis

et al. 2015

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Background:Hemophagocytic lymphohistiocytosis (HLH) is an uncommon, potentially fatal, hyperinflammatory syndrome that may rarely complicate the clinical course of disseminated Mycobacterium tuberculosis (MTB). The clinical course of tuberculosis-associated HLH (TB-HLH) has been reported to be unpredictable.Materials and Methods:Here we describe the clinicopathological features, laboratory parameters, management, and outcome data of a patient who satisfied the 2004 diagnostic criteria for HLH secondary to disseminated MTB; we also do a systematic review of the international literature on TB-HLH. The literature review (January 1975–March 2014) found that HLH complicated the clinical course of 63 tuberculosis patients (41 males, 22 females, mean age = 45 ± 23.5 years) with a high mortality rate of 49% (31/63 died). The mean serum ferritin level (n = 44/63) was 5963 ng/mL (range 500–38,539 ng/mL); and a higher proportion (54.2%) of patients had pancytopenia at presentation. On univariate analysis (n = 53/63), age >30 years [hazard ratio (HR): 2.79, 95% confidence interval (CI):1.03–7.56, P = 0.03], presence of comorbidities (HR 4.59, CI: 1.08–19.52, P = 0.04), marked hemophagocytosis in bone marrow (HR: 2.65, CI: 1.16–6.05, P = 0.02), and nonusage/delayed usage of antitubercular therapy (ATT) (HR: 3.44, CI: 1.51–7.87, P = 0.003) were associated with decreased survival, though none of these parameters attained statistical significance (P > 0.05) in multivariate analysis. Usage of corticosteroids and/or immunomodulator drugs (HR 1.00, CI: 0.66–3.22, P = 0.35) did not alter the outcome in these patients.Conclusion:HLH should be considered as a differential diagnosis in patients with tuberculosis who present with cytopenias, organomegaly, and coagulopathy. Strong clinical suspicion and early usage of ATT might be useful in reducing the morbidity and mortality. The utility of immunosuppressive/immunomodulator therapy lacks general concensus among treating physicians, and warrants further studies.

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Section: Methodsmentioning

confidence: 99%

Hemophagocytic lymphohistiocytosis: An unusual complication in disseminated Mycobacterium tuberculosis

et al. 2015

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“…In some situations, patients require immunomodulatory therapy, including steroids and intravenous immunoglobulin (IVIG). Most previous TB-HLH cases were treated with anti-TB therapy with or without steroids [5]. Our patient experienced rapid deterioration and required more intensive management.…”

Section: Discussionmentioning

confidence: 80%

Successful treatment of mycobacterial infection associated hemophagocytic lymphohistiocytosis with etoposide and anti-tuberculous therapy: a case report

Wang

Shi

et al. 2020

BMC Infect Dis

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Background: Hemophagocytic lymphohistiocytosis (HLH) is a rare and potentially life-threatening disorder characterized by an exacerbated but ineffective inflammatory response, which can be classified as primary and secondary HLH. HLH associated with Mycobacterium tuberculosis is uncommon. This case report accounted an immunocompetent patient who was confirmed to be Mycobacterium infection, or rather, highly suspected tuberculosis (TB) associated HLH, with a favorable outcome. Case presentation: A 36-year-old man presented with persistent fever, pancytopenia, and hyperferritinemia. A bone marrow smear demonstrated hemophagocytosis, and pathological examination of lung biopsy was positive for acid-fast bacilli, which established the diagnosis of Mycobacterium infection and HLH. Then the patient treated successfully with anti-TB therapy, along with 8 weeks of etoposide. Conclusion: This case emphasizes that HLH should be kept in mind when clinicians encounter a patient with severe infection presenting with pancytopenia and hyperferritinemia. Given the high mortality, early diagnosis and appropriate therapy can provide patients with a favorable prognosis.

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“…Among bacterial infections associated with HLH, there were published associations with Borrelia, [19]-Babesia sp, [20] Bartonella sp, [21] Brucella sp, [22] Q fever, [23] Leptospira sp, [24] Listeria monocytogenes, [25] Mycoplasma pneumoniae, [26] and mycobacteria. [27][28][29][30][31][32] The most frequently described parasitic causes responsible for secondary HLH are: Leishmania sp, [33,34] malaria, [35][36][37] and Toxoplasma gondii. [38,39] Fungal infections are found to be associated with secondary HLH in HIV-infected patients such as Cryptococcus neoformans, [40] Candida spp, [41] or in patients with renal transplantation-association with disseminated histoplasmosis.…”

Section: Discussionmentioning

confidence: 99%

Sepsis due to Streptococcus pneumoniae associated with secondary hemophagocytic lymphohistiocytosis in a splenectomized patient for spherocytosis

Bîrluțiu

Bîrluţiu

2017

Medicine

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Rationale:Hemophagocytic lymphohistiocytosis (HLH) is a syndrome that is characterized by an inappropriate hyperinflammatory immune response – primary, as a consequence of a genetic defect of NK cells and cytotoxic T lymphocytes or – secondary, in the progression of infections, rheumatic or autoimmune diseases, malignancies or metabolic diseases.Patient concerns:We present the case of a secondary HLH due to Streptococcus pneumoniae infection in a splenectomised patient for spherocytosis, a 37-year-old patient who was splenectomised in childhood for spherocytosis, without immuneprophylaxis induced by antipneumococcal vaccine.Outcomes:He developed a severe pneumococcal sepsis associated with secondary HLH, with unfavorable outcome and death.Lessons:To our knowledge, just 2 similar cases had been published in the literature, none in which the secondary HLH was the consequence of an invasive pneumococcal infection in a splenectomized patient for spherocytosis, and the association of splenectomy with HLH is surprizin.

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A case of tuberculosis-induced hemophagocytic lymphohistiocytosis in a patient under hemodialysis

Cited by 17 publications

References 22 publications

Hemophagocytic lymphohistiocytosis: An unusual complication in disseminated Mycobacterium tuberculosis

Hemophagocytic lymphohistiocytosis: An unusual complication in disseminated Mycobacterium tuberculosis

Successful treatment of mycobacterial infection associated hemophagocytic lymphohistiocytosis with etoposide and anti-tuberculous therapy: a case report

Sepsis due to Streptococcus pneumoniae associated with secondary hemophagocytic lymphohistiocytosis in a splenectomized patient for spherocytosis

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