Haemophagocytic lymphohistiocytosis (HLH) secondary to miliary tuberculosis

Ranjan, Ashish; Pal, Ramesh Singh; Kumar, Amit; Ojha, Umesh Chandra

doi:10.1016/j.ijtb.2019.08.006

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…Debaugnies et al concluded in their study that HScore performs better than HLH-04 at the initial presentation, and that when patients deteriorated, the difference in performance diminished when comparing the two [ 16 ]. Despite studies showing the superior performance of HScore when compared to HLH-04 [ 15 , 16 ], there were only a few cases in this study where HScore was utilized [ 13 , 96 ].…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis-Associated Hemophagocytic Lymphohistiocytosis: A Review of Current Literature

Fauchald,

Blomberg,

Reikvam

2023

JCM

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Hemophagocytic lymphohistiocytosis (HLH) is a condition of immune dysregulation and hyperinflammation, leading to organ failure and death. Malignancy, autoimmune conditions, and infections, including Mycobacterium tuberculosis (TB), are all considered triggers of HLH. The aim of this study was to review all reported cases of TB-associated HLH in English literature, and to summarize the epidemiology, diagnostics, treatment, and mortality in patients with concomitant HLH and TB. A systematic review of described cases with TB-associated HLH, via a structured literature search in the medical database PubMed, is presented. Additional articles were included through cross-referencing with existing review articles. Articles were reviewed based on a predetermined set of criteria. A total of 116 patients with TB-associated HLH were identified with a male:female ratio of about 3:2. The age at presentation ranged from 12 days to 83 years. Malignancy, autoimmunity, and renal failure were the most common comorbid conditions. Most patients received both tuberculostatic and specific immunomodulating treatment, which was associated with a 66% (48/73) survival rate compared to 56% (15/27) in those receiving only tuberculostatic treatment, and 0% (0/13) in those receiving only immunomodulating treatment. The survival rate was 55% overall. The overlapping presentation between disseminated TB and HLH poses challenging diagnostics and may delay diagnosis and treatment, leading to increased mortality. TB should be considered as a potential trigger of HLH; clinicians’ knowledge and awareness of this may result in the appropriate investigations needed to ensure diagnosis and proper treatment.

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Section: Discussionmentioning

confidence: 99%

Tuberculosis-Associated Hemophagocytic Lymphohistiocytosis: A Review of Current Literature

Fauchald,

Blomberg,

Reikvam

2023

JCM

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“…In 2006, Brastianos et al reported that approximately 68% of cases of TB-associated HLH received a combination of ATT and immunomodulatory treatment (mainly corticosteroids), and 60% of them survived (22). In a literature review for the past 5 years, approximately 60% of TB associated-HLH cases were treated with corticosteroids (23)(24)(25)(26). Corticosteroid has also been applied to more severe nontuberculosis mycobacterium infection-associated HLH (27).…”

Section: Discussionmentioning

confidence: 99%

Disseminated Tuberculosis Associated Hemophagocytic Lymphohistiocytosis in a Pregnant Woman With Evans syndrome: A Case Report and Literature Review

Shi

Zhang

et al. 2021

Front. Immunol.

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BackgroundTuberculosis (TB) is a leading cause of morbidity and mortality in underdeveloped and developing countries. Disseminated TB may induce uncommon and potentially fatal secondary hemophagocytic lymphohistiocytosis (HLH). Timely treatment with anti-tuberculosis therapy (ATT) and downmodulation of the immune response is critical. However, corticosteroid treatment for TB-associated HLH remains controversial. Herein, we report a successful case of disseminated TB-associated HLH in a pregnant woman with Evans syndrome accompanied by a literature review.Case PresentationA 26-year-old pregnant woman with Evans syndrome was transferred to the Third Affiliated Hospital of Sun Yat-Sen University because of severe pneumonia. She presented with cough, fever, and aggravated dyspnea. Nested polymerase chain reaction for Mycobacterium tuberculosis (M. tuberculosis) complex in sputum was positive. Sputum smear sample for acid-fast bacilli was also positive. Metagenome next-generation sequencing (mNGS) of the bronchoalveolar lavage fluid identified 926 DNA sequence reads and 195 RNA sequence reads corresponding to M. tuberculosis complex, respectively. mNGS of blood identified 48 DNA sequence reads corresponding to M. tuberculosis. There was no sequence read corresponding to other potential pathogens. She was initially administered standard ATT together with a low dose of methylprednisolone (40 mg/day). However, her condition deteriorated rapidly with high fever, acute respiratory distress syndrome, pancytopenia, and hyperferritinemia. Bone marrow smears showed hemophagocytosis. And caseating tuberculous granulomas were found in the placenta. A diagnosis of disseminated TB-associated HLH was made. Along with the continuation of four drug ATT regimen, therapy with a higher dose of methylprednisolone (160 mg/day) combined with immunoglobulin and plasma exchange was managed. The patient’s condition improved, and she was discharged on day 19. Her condition was good at follow-up with the continuation of the ATT.ConclusionsClinicians encountering patients with suspected TB accompanied by unexplainable inflammation not responding to ATT should consider complications with HLH. Timely administration of ATT combined with corticosteroids may result in a favorable outcome.

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Disseminated tuberculosis complicated by intramuscular abscesses, meningoencephalitis, and hemophagocytic lymphohistiocytosis: a case report

Liu,

Huang,

Jiao

2024

BMC Infect Dis

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Background As disseminated extrapulmonary tuberculosis infection can involve multiple systems and result in atypical clinical manifestations that mimic other diseases, the diagnosis may be difficult, especially in elderly patients. Delaying treatment can adversely affect the prognosis. And to achieve better prognosis, early detection and diagnosis are necessary, as well as early initiation of comprehensive treatment. Case presentation We present the case of a 78-year-old man with disseminated tuberculosis who developed the uncommon complication of urinary retention due to a psoas abscess, meningoencephalitis, and the rare secondary hemophagocytic lymphohistiocytosis syndrome. The patient achieved a favorable outcome following targeted therapy with antitubercular medications. Conclusions This case highlights that disseminated extrapulmonary tuberculosis infection can present with a variety of manifestations, and may exhibit many rare and complex clinical presentations. Prompt and accurate diagnosis and treatment play a crucial role in improving prognosis for the patients with persistent fever.

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Haemophagocytic lymphohistiocytosis (HLH) secondary to miliary tuberculosis

Cited by 3 publications

References 14 publications

Tuberculosis-Associated Hemophagocytic Lymphohistiocytosis: A Review of Current Literature

Tuberculosis-Associated Hemophagocytic Lymphohistiocytosis: A Review of Current Literature

Disseminated Tuberculosis Associated Hemophagocytic Lymphohistiocytosis in a Pregnant Woman With Evans syndrome: A Case Report and Literature Review

Disseminated tuberculosis complicated by intramuscular abscesses, meningoencephalitis, and hemophagocytic lymphohistiocytosis: a case report

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