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

Abstract

We present an unusual hematologic manifestation of tuberculosis in a hemodialysis patient. A 37-year-old man was admitted because of fever, anorexia and weight loss which developed 3 months earlier. He previously received a renal transplant and commenced hemodialysis 1 year ago. Physical examination revealed hepatomegaly, and peripheral blood counts revealed pancytopenia. The delayed bone marrow biopsy demonstrated marked hemophagocytosis, granuloma and tubercle bacilli by the acid-fast stain. The clinical course was fatal and he died without definite treatment. Through this case, we would like to recommend early bone marrow biopsy and antituberculosis therapy if fever of unknown origin, anorexia, weight loss, hepatomegaly and pancytopenia develop in patients undergoing dialysis.

Hemophagocytic Syndrome as an Unusual Form of Presentation of Tuberculosis in a Hemodialysis Patient

“…The course of the only case that we have known in hemodialysis patients was fatal [20]. In our case, with the tuberculostatic therapy the patient achieved a clinical and laboratory cure.…”

“…On the basis of this we can speculate that it could occur both by a primary alteration in the phagocytic cells or in the ingested elements. It is not clear if tuberculosis bacilli themselves or other mediators could contribute to the hemophagocytosis [20].…”

“…There are 10 cases reported of tuberculosis associated with hemophagocytic syndrome [15][16][17][18][19][20], and we only know one report of patients on chronic hemodialysis [20]. We present a case of hemophagocytosis associated with tuberculosis where the antituberculosis therapy brought about the cure of the process.…”

Hemophagocytic Syndrome in a Patient with Hashimoto’s Thyroiditis and Membranous Nephritis

“…Clinical findings such as the rash on her face and extremities, high fever, dyspnea, peripheral blood pancytopenia and hemophagocytosis on bone marrow aspiration were sufficient to diagnose HPS caused by parainfluenza virus. Under performance of hemodialysis, virus-associated HPS has been reported to have a poor prognosis and a high mortality [3]. In our patient, infection by parainfluenza virus in the presence of immunosuppression, autoimmune disease [6], and uremia may have resulted in multiple organ failure.…”

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.…”