Disseminated Tuberculosis Complicated by the Hemophagocytic Syndrome

Abstract

A 43-year-old Polynesian presented with fever, abnormal liver function tests, bilateral pulmonary infiltrates, and a progressive neutropenia and thrombocytopenia. Bone marrow examination showed extensive and striking hemophagocytosis which raised the diagnosis of malignant histiocytosis. Mycobacterium tuberculosis was subsequently cultured from both urine and bone marrow. Hemophagocytosis is now a recognised association of several infections and we draw attention to this finding, particularly as the confident exclusion of malignancy can be very difficult and management is obviously very different.

Tuberculosis-Associated Hemophagocytic Syndrome in a Hemodialysis Patient: Case Report and Review of the Literature

“…Tuberculo sis-associated hemophagocytic syndrome is an unusual hematologic manifestation. Until now, 9 cases were reported as a single report in various diseases [5,[17][18][19][20] but hemophagocytic syndrome in uremic patients has not been reported. However, we think more cases will be reported if invasive diagnostic methods (e.g.…”

“…Most cases of tuberculosisassociated hemophagocytic syndrome were confirmed by postmortem bone marrow biopsy and only 1 case was cured by antituberculous medication [5,[17][18][19][20], A bone marrow biopsy is often delayed due to bleeding tendency and poor general condition at admission. Therefore, bone marrow' biopsy and trial of antituberculous therapy are warranted in patients undergoing dialysis in whom fever of unknown origin, anorexia, weight loss, hepatomegaly and pancytopenia develop particularly in areas endemic for tuberculosis.…”

Autoimmune-associated hemophagocytic syndrome

“…To date, reactive HPS has been reported to be associated not only with virus and bacteria infection, but also with various types of disseminated infections such as tuberculosis, fungi, and parasites. [6][7][8][9][10][11][12][13] Thus, HPS associated with underlying infection is collectively called infection-associated hemophagocytic syndrome (IAHS).…”

Reaktives Hämophagozytosesyndrom als seltene Ursache einer fatalen Panzytopenie

“…Unter Berücksichtigung des initialen klinischen Bildes einer fieberhaften Allgemeinerkrankung halten wir jedoch trotz fehlenden serologischen Beweises die Diagnose eines infektassoziierten Hä-mophagozytosesyndroms (IAHS) für sehr wahrscheinlich, insbesondere da seronegative Verläufe nicht selten sind [8]. Das infektassoziierte Hämophago-zytosesyndrom wurde zuerst 1979 als virusassoziiert beschrieben [44], mittlerweile gibt es Beschreibungen von infektassoziierten Hämophagozytosesyn-dromen bei verschiedensten Infektionserkrankungen durch Bakterien [14,24,26,43,54,57,60], Mykobakterien [2,4,5,9,31,56,59], Mykoplasmen [12], Leishmanien [3,6,28,33], Parasitosen [11], Mykosen [37] und Plasmodien [39]. Bei fehlenden epidemiologischen Daten gilt die Erkrankung als sehr selten.…”