title: A case of tuberculosis-induced hemophagocytic lymphohistiocytosis in a patient under hemodialysis.
abstract: 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.
authors.affiliation: Department of Oncology and Hematology, Mackay Memorial Hospital, B2 Floor Oncology/Hematology Office, 92, Sec 2, Chung-Shan North Rd, Taipei, Taiwan.
authors.forename: Nai-Wen
authors.initials: NW
authors.lastname: Su
authors.affiliation: Department of Pathology, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Chi-Kuan
authors.initials: CK
authors.lastname: Chen
authors.affiliation: 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.
authors.forename: Gon-Shen
authors.initials: GS
authors.lastname: Chen
authors.affiliation: Department of Oncology and Hematology, Mackay Memorial Hospital, B2 Floor Oncology/Hematology Office, 92, Sec 2, Chung-Shan North Rd, Taipei, Taiwan.
authors.forename: Ruey-Kuen
authors.initials: RK
authors.lastname: Hsieh
authors.affiliation: 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.
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Chang
mesh_terms: 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