A case of tuberculosis-induced hemophagocytic lymphohistiocytosis in a patient under hemodialysis.
The insidious onset, but rapid progression of hemophagocytic lymphohistiocytosis is always a diagnostic challenge. Herein, we report the case involving a 58-year-old man with diabetes-related nephropathy on dialysis who presented with fever of unknown origin, pancytopenia, and splenomegaly. A bone marrow smear showed extensive hemophagocytosis and the pathology disclosed granulomatous inflammation with caseous necrosis, suggestive of tuberculosis. Sputum culture and polymerase chain reaction confirmed tuberculosis. The patient exhibited signs of multiple-organ failure that were not reversed with anti-tuberculous medications and corticosteroids. The case reminds us that this is an uncommon clinical scenario, and only a timely diagnosis with prompt treatment results in a favorable outcome.
Su
Nai-Wen
NW
Department of Oncology and Hematology, Mackay Memorial Hospital, B2 Floor Oncology/Hematology Office, 92, Sec 2, Chung-Shan North Rd, Taipei, Taiwan.
Chen
Chi-Kuan
CK
Department of Pathology, Mackay Memorial Hospital, Taipei, Taiwan.
Chen
Gon-Shen
GS
Department of Oncology and Hematology, Mackay Memorial Hospital, B2 Floor Oncology/Hematology Office, 92, Sec 2, Chung-Shan North Rd, Taipei, Taiwan.|Mackay Medicine, Nursing, and Management College, Taipei, Taiwan.
Hsieh
Ruey-Kuen
RK
Department of Oncology and Hematology, Mackay Memorial Hospital, B2 Floor Oncology/Hematology Office, 92, Sec 2, Chung-Shan North Rd, Taipei, Taiwan.
Chang
Ming-Chih
MC
Department of Oncology and Hematology, Mackay Memorial Hospital, B2 Floor Oncology/Hematology Office, 92, Sec 2, Chung-Shan North Rd, Taipei, Taiwan. mmhdonald@yahoo.com.tw.|Mackay Medicine, Nursing, and Management College, Taipei, Taiwan. mmhdonald@yahoo.com.tw.
D003928:Diabetic Nephropathies / Q000150:complications / Q000628:therapy; D006801:Humans; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D014376:Tuberculosis / Q000209:etiology* / Q000473:pathology