Hemophagocytic Lymphohistiocytosis and Miliary Tuberculosis in an Apparently Immunocompetent Patient: A Case Report

Autor: Filippo Ducci, Francesca Mariotti, Jessica Mencarini, Claudio Fabbri, Alessandra Francesca Manunta, Daniela Messeri, Paola Parronchi, Pierluigi Blanc, Alessandro Bartoloni
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: Infectious Disease Reports, Vol 16, Iss 4, Pp 763-769 (2024)
Druh dokumentu: article
ISSN: 16040058
2036-7449
DOI: 10.3390/idr16040058
Popis: Hemophagocytic lymphohistiocytosis (HLH) is a serious haematologic condition that can be related to various diseases, including tuberculosis (TB). The patient is a previously healthy 26-year-old man, originally from western Africa, admitted to hospital for fever and weight loss. Given the results of a computed tomography (CT) scan, ocular examination and microbiologic tests, miliary TB with pulmonary, lymph nodal and ocular involvement was diagnosed. Following the introduction of antitubercular treatment (ATT), an increase in inflammation indexes and severe pancytopenia were observed; at this point, the patient presented with six of the eight diagnostic criteria for HLH, and a diagnosis of HLH secondary to TB was raised. Therefore, HLH treatment with a high dose of dexamethasone was started, with a good clinical response. We performed a literature review of TB-related HLH, which shows a high mortality rate. ATT is necessary to ensure patient survival to remove the antigenic driver. Our patient developed HLH after the initiation of ATT as a paradoxical reaction, which may be linked to the release of antigens due to the bactericidal effect of ATT.
Databáze: Directory of Open Access Journals
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