[A case of hemophagocytic syndrome associated with miliary tuberculosis].
We reported a case of a 76-year-female with hemophagocytic syndrome caused by military tuberculosis. The patients had complained high fever over 38.0 degrees C and anorexia. Her chest X-ray and computed tomography revealed disseminated miliary shadows in both lung fields. Laboratory examinations revealed anemia, thrombocytopenia and liver dysfunction. Bonemarrow aspirate revealed tuberculous granulomas and tubercle bacilli by acid-fast stains, and hemophagocytosis by macrophages. We diagnosed as miliary tuberculosis and tuberculosis-associated hemophagocytic syndrome, and started antituberculous and steroid therapy. After these therapy, fever, laboratory examinations dramatically improved. In this case, serum IL-18, sICAM-1, sVCAM-1 were elevated. These cytokines and adhesion molecules were reported to elevate in both hemophagocytic syndrome and tuberculosis correlating with disease activity. We conclude that IL-18, sICAM-1, sVCAM-1 may play important roles in pathogenesis of tuberculosis associated hemophagocytic syndrome.
Fujiki
Rei
R
First Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-cho, Kurume-shi, Fukuoka 839-0011, Japan.
Shiraishi
Kaori
K
Noda
Kazuhito
K
Ohshita
Yuichi
Y
Fukahori
Shigeki
S
Johjima
Hiroto
H
Tanaka
Ken
K
Rikimaru
Toru
T
Aizawa
Hisamichi
H
D000368:Aged; D015415:Biomarkers; D005260:Female; D015616:Histiocytosis, Non-Langerhans-Cell / Q000209:etiology*; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood / Q000502:physiology; D020382:Interleukin-18 / Q000097:blood / Q000502:physiology; D014391:Tuberculosis, Miliary / Q000150:complications*; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood / Q000502:physiology
D015415:Biomarkers; D020382:Interleukin-18; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1