title: Hemophagocytic syndrome associated with bilateral adrenal gland tuberculosis.
abstract: We report a case of a patient who presented with hemophagocytic syndrome (HPS) and adrenal crisis associated with bilateral adrenal gland tuberculosis, and resulted in a poor outcome. A 50-year-old man was transferred to our hospital from a local clinic due to fever, weight loss, and bilateral adrenal masses. Laboratory findings showed leukopenia, mild anemia, and elevated lactate dehydrogenase. Computed tomography (CT) of the abdomen revealed bilateral adrenal masses and hepatosplenomegaly. CT-guided adrenal gland biopsy showed numerous epithelioid cells and infiltration with caseous necrosis consistent with tuberculosis. Bone marrow aspiration and biopsy showed significant hemophagocytosis without evidence of malignancy, hence HPS associated with bilateral adrenal tuberculosis was diagnosed. During anti-tuberculosis treatment the patient showed recurrent hypoglycemia and hypotension. Rapid ACTH stimulation test revealed adrenal insufficiency, and we added corticosteroid treatment. But pancytopenia, especially thrombocytopenia, persisted and repeated bone marrow aspiration showed continued hemophagocytosis. On treatment day 41 multiple organ failure occurred in the patient during anti-tuberculous treatment and steroid replacement.
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Byung-Chul
authors.initials: BC
authors.lastname: Shin
authors.forename: Shin-Woo
authors.initials: SW
authors.lastname: Kim
authors.forename: Sang-Woo
authors.initials: SW
authors.lastname: Ha
authors.forename: Jong-Won
authors.initials: JW
authors.lastname: Sohn
authors.forename: Jong-Myung
authors.initials: JM
authors.lastname: Lee
authors.forename: Nung-Soo
authors.initials: NS
authors.lastname: Kim
mesh_terms: D000307:Adrenal Gland Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D000995:Antitubercular Agents / Q000627:therapeutic use; D015616:Histiocytosis, Non-Langerhans-Cell / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014383:Tuberculosis, Endocrine / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid