Hemophagocytic Syndrome-Like Tuberculosis-Immune Reconstitution Inflammatory Syndrome After the Initiation of Hepatic Tuberculosis Treatment

Abstract

A 25-year-old Nepalese woman was referred to our hospital because of fever and intermittent abdominal pain with inguinal lymphadenopathy, which had lasted for several months. A liver biopsy of the positron emission tomography-positive lesion led to a diagnosis of hepatic tuberculosis. After the initiation of antituberculosis treatment, her symptoms resolved. However, 11 days after treatment initiation, chest and back pain, high-grade fever, and vomiting appeared and gradually worsened. She developed anemia and her serum ferritin level was elevated. Hemophagocytic syndrome due to the initial deterioration of tuberculosis was suspected and steroid therapy was initiated with the continuation of the antituberculosis drugs. Thereafter, the patient’s condition improved remarkably.

Pleural infection caused by Mycobacterium kansasii in a patient after lung transplantation

“…Tacrolimus doses after initiation of NTM therapy were quintuplicated to reach target levels. The dosage of prednisolone was increased temporarily in order to prevent allograft rejection and immune reconstitution inflammatory syndrome (IRIS) [13] . The laboratory results improved, the fever disappeared after two weeks, chest pain resolved and pulmonary function tests showed stable parameters.…”