Tuberculosis-associated hemophagocytic syndrome in a hemodialysis patient with protracted fever.
Hemophagocytic syndrome (HPS) is a clinicopathological reflection of uncontrolled activation of macrophages. To our knowledge, only a few cases of tuberculosis-associated HPS in hemodialysis have been reported in the English literature. We report a case of tuberculosis-associated HPS during hemodialysis. Bone marrow aspiration showed histiocytosis with hemophagocytosis; in addition, results of acid-fast staining and polymerase chain reaction showed the presence of acid-fast bacilli. Mycobacterium tuberculosis was subsequently cultured from sputum. The patient received late treatment with antituberculosis agents combined with intravenous immunoglobulin and had a poor response. On the basis of the results in this case, we recommend early bone marrow and tuberculous examination for patients undergoing maintenance hemodialysis who have fever of unknown origin.
Chien
Chih-Chiang
CC
Division of Medical Oncology, Department of Medicine, Department of Pathology, Taipei Veterans General Hospital and National Yang-Ming University, 201, Sec 2, Shih-Pai Road, Taipei 112, Taiwan.
Chiou
Tzeon-Jye
TJ
Lee
Ming-Yang
MY
Hsiao
Liang-Tsai
LT
Kwang
Wei-Kang
WK
D000368:Aged; D001856:Bone Marrow Examination; D017809:Fatal Outcome; D005334:Fever / Q000209:etiology; D015616:Histiocytosis, Non-Langerhans-Cell / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D006435:Renal Dialysis / Q000009:adverse effects*; D014376:Tuberculosis / Q000150:complications* / Q000175:diagnosis / Q000209:etiology