Pancytopaenia associated with disseminated tuberculosis, reactive histiocytic haemophagocytic syndrome and tuberculous hypersplenism

Cassim, K.M.; Gathiram, V.; Jogessar, V.

doi:10.1016/0962-8479(93)90014-o

Cited by 19 publications

(8 citation statements)

References 12 publications

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“…Three (11.1%) of ourp atients hadh aemophagocytosis, whichi sa nother rare haematologic manifestation of TB (25,(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43). The mechanisms of TB that cause haemophagocytosis are unknown.…”

Section: Discussionmentioning

confidence: 89%

Mycobacterium tuberculosis inducing disseminated intravascular coagulation

Wang

Hsueh²,

Lee³

et al. 2005

Thromb Haemost

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Disseminated intravascular coagulation (DIC) can develop infrequently in patients with tuberculosis and has a very high mortality rate. We conducted a retrospective study to evaluate the incidence of tuberculosis-induced DIC and to investigate the clinical manifestation, outcome, and prognostic factors of such patients. From January 2002 to December 2003, all culture-proven tuberculosis patients who developed DIC before starting anti-tuberculosis treatments were selected for this study. Patients who had other clinical conditions or were infected by other pathogens that may have been responsible for their DIC were excluded. Survival analysis was performed for each variable with possible prognostic significance. Our results showed that 27 (3.2%) out of the 833 patients with culture-proven tuberculosis had tuberculosis-induced DIC with a mortality rate of 63.0%. The most common clinical manifestations were fever (63.0%) and multiple patches of pulmonary consolidation (59.3%). Seven (25.9%) patients had disseminated tuberculosis. Twelve (44.4%) developed acute respiratory distress syndrome and three (11.1%) were associated with hemophagocytosis. Twenty-four (88.9%) patients had findings that were unusual for an acute bacterial infection, such as positive acid-fast smear, miliary pulmonary lesions, lymphocytotic exudative pleural effusion, and mediastinal lymphadenopathy. Early anti-tuberculosis treatment significantly improved survival. In conclusion, tuberculosis can cause DIC. Patients with non-miliary, non-disseminated tuberculosis could also develop the rare clinical manifestation. Since the prognosis was very poor in patients not treated at an early stage, a high index of suspicion is required, especially in those with clinical findings suggestive of tuberculosis.

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Section: Discussionmentioning

confidence: 89%

Mycobacterium tuberculosis inducing disseminated intravascular coagulation

Wang

Hsueh²,

Lee³

et al. 2005

Thromb Haemost

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“…In emergency situations, plasma exchange [43] or the early administration of high‐dose IVIG [44–46] might be beneficial. Except for diagnostic information, splenectomy may offer at least some therapeutic benefit, although sometimes only temporary, in infection‐associated cases [47–51]. In T‐ and B‐cell lymphomas with RHS, the prognosis with standard chemotherapy regimens has largely been poor [9, 11–13, 19, 52].…”

Section: Discussionmentioning

confidence: 99%

Hodgkin's lymphoma, Epstein–Barr virus reactivation and fatal haemophagocytic syndrome

Hasselblom

Linde

Ridell

2004

Journal of Internal Medicine

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Haemophagocytic syndrome is a serious disorder, often related to Epstein-Barr virus (EBV) or other infectious agents. Frequently an underlying immune abnormality or a T-cell lymphoma is present. The combination of haemophagocytosis and Hodgkin's lymphoma seems to be rare. A 70-yearold female with rheumatoid arthritis was admitted with constitutional symptoms, persistent fever, pancytopenia, deranged liver enzymes, lymphadenopathy and splenomegaly. A fatal coagulopathy supervened. The clinical picture and the bone marrow findings indicated a haemophagocytic syndrome and a lymph node biopsy disclosed an EBV-positive Hodgkin's lymphoma. EBV serology pointed at viral reactivation and a high EBV DNA content was detected in serum by real-time quantitative PCR analysis (5.5 · 10 6 copies per mL). The case history is presented and the literature is reviewed.

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“…The association of hemophagocytic syndrome with tuberculosis remains very rare. The subject has been discussed for several years: in 1993, Cassim et al [ 8 ] reported what they called a reactive histiocytic hemophagocytosis associated with disseminated tuberculosis; in 1995 and 1996, Quinquandon et al [ 9 ] and Undar et al [ 10 ] respectively reported two cases of hemophagocytosis associated with tuberculosis; in 1998, Francois et al attempted to link pancytopenia of tuberculosis to hemophagocytosis. Hemophagocytic syndrome is mainly found in extrapulmonary tuberculosis.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, splenic tuberculosis, a rare entity (68 cases reported in the literature in the last ten years [ 12 ]), is often associated with synchronous liver involvement and is usually not accompanied by hemophagocytosis [ 8 ].…”

Section: Discussionmentioning

confidence: 99%