Secondary hemophagocytic lymphohistiocytosis: an unusual complication in disseminated Mycobacterium tuberculosis

Tuberculosis-associated hemophagocytic lymphohistiocytosis (TB-HLH) is a rare and life-threatening complication of tuberculosis infection. Early recognition and treatment of TB-HLH is crucial for improving outcomes. Treatment typically involves a combination of antituberculosis therapy and immunosup...

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Bibliographic Details
Published in:Clinical medicine (London, England) England), 2023-07, Vol.23 (4), p.414-416
Main Authors: Ing, Shan Kai, Lee, Grace Wan Chieng, Leong, Tze Shin, Lee, Yih Hoong, Lau, George Yew Liang, Yusof, Nur Nazihah, Chang, Andrew Kean Wei, Wong, Kelly Kee Yung
Format: Article
Language:English
Subjects:
Abdomen
Abscesses
Blood
Bone marrow
Case reports
Clinical Lesson of the Month
dexamethasone
Fever
Health care
Hematology
hemophagocytic lymphohistiocytosis
Immunoglobulins
Infections
Infectious diseases
intravenous immunoglobulin
Lymphatic diseases
Mortality
Patients
Respiratory distress syndrome
Tuberculosis
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Summary:Tuberculosis-associated hemophagocytic lymphohistiocytosis (TB-HLH) is a rare and life-threatening complication of tuberculosis infection. Early recognition and treatment of TB-HLH is crucial for improving outcomes. Treatment typically involves a combination of antituberculosis therapy and immunosuppressive therapy to control the immune system's overreaction. In this report, we present the case of a 53-year-old ambulance driver who was diagnosed with TB-HLH. His CT scan revealed splenic abscesses, hepatomegaly and bilateral lung consolidation. He subsequently developed multiorgan failure, including acute respiratory distress syndrome (ARDS), transaminitis and bone marrow dysfunction. The clinical course and simultaneous increase in serum ferritin raised the suspicion of HLH. His Hscore was 254, indicating a high probability of hemophagocytic syndrome. TB diagnosis was confirmed by positive endotracheal TB GeneXpert and bone marrow aspiration (BMA) which detected acid-fast bacilli organisms. The patient was promptly started on anti-TB, dexamethasone and IVIG. The patient responded well to treatment and made a full recovery without any lasting complications. This case highlights the importance of promptly recognising HLH and identifying the underlying cause. In critically ill patients, it is crucial not to delay HLH-specific treatment while working up for differential diagnosis.
ISSN:1470-2118
1473-4893
DOI:10.7861/clinmed.2023-0171