Tuberculosis-associated HLH in a patient with chronic kidney disease on haemodialysis.
Journal
Oxford medical case reports
ISSN: 2053-8855
Titre abrégé: Oxf Med Case Reports
Pays: England
ID NLM: 101642070
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
07
05
2020
revised:
16
06
2020
accepted:
30
07
2020
entrez:
2
11
2020
pubmed:
3
11
2020
medline:
3
11
2020
Statut:
epublish
Résumé
Haemophagocytic lymphohistiocytosis (HLH) is a rare immunological disorder that is accompanied by a high mortality rate when the underlying aetiology is miliary tuberculosis. We report a case of tuberculosis (TB)-associated HLH in a haemodialysis patient, from a TB-endemic region, who missed two sessions of dialysis before developing the primary symptoms of HLH. The patient presented with non-specific findings including pancytopenia, coagulopathy and transaminitis. Computer-tomography imaging and microbiology from bronchoalveolar lavage evidenced miliary tuberculosis. Further testing revealed the TB-associated-HLH characteristic pattern of thrombocytosis, leukopenia, transaminitis, hyperferritinemia and elevated fibrinogen. The patient initially demonstrated improvement after initiation of anti-TB therapy. However, soon thereafter began to paradoxically deteriorate and then expire from apparent tuberculosis-immune reconstitution inflammatory syndrome. This case highlights the importance of early diagnosis and treatment, and consequently of the utility of diagnostic systems such as the HScore in cases of high clinical suspicion.
Identifiants
pubmed: 33133616
doi: 10.1093/omcr/omaa082
pii: omaa082
pmc: PMC7583401
doi:
Types de publication
Case Reports
Langues
eng
Pagination
omaa082Informations de copyright
© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
Références
Pediatr Blood Cancer. 2007 Feb;48(2):124-31
pubmed: 16937360
Lancet Infect Dis. 2006 Jul;6(7):447-54
pubmed: 16790385
Cancer. 2016 Sep 15;122(18):2857-66
pubmed: 27244347
Lung India. 2015 Nov-Dec;32(6):593-601
pubmed: 26664166
J Clin Tuberc Other Mycobact Dis. 2016 Mar 11;3:6-9
pubmed: 31723680
Intensive Care Med. 2008 Jul;34(7):1177-87
pubmed: 18427781
Cytokine Growth Factor Rev. 2015 Jun;26(3):263-80
pubmed: 25466631
Mayo Clin Proc. 2014 Apr;89(4):484-92
pubmed: 24581757
Arthritis Rheumatol. 2014 Sep;66(9):2613-20
pubmed: 24782338
BMC Nephrol. 2019 Jan 29;20(1):27
pubmed: 30696397