title: [Tuberculosis associated with hemophagocytic syndrome complicated by treatment with infliximab].
abstract: We report a case of tuberculosis associated with hemophagocytic syndrome (HPS) which was complicated by treatment with infliximab for Crohn's disease. A 48-year-old woman was admitted because of fever, diarrhea and general malaise. Her condition did not improve with treatment for recurrence of Crohn's disease, and an abnormal shadow was pointed out on chest imaging. She was referred to our department and received a diagnosis of tuberculosis based on the results of smear and polymerase chain reaction examination of the sputum and bone marrow. HPS was suspected based on subsequent results such as hepatosplenomegaly, leukocytopenia, elevated ferritin, disseminated intravascular coagulation, hemophagocytosis of nucleated red cells, and leukocytes in the bone marrow. She was treated with antituberculous drugs, steroids and gamma globulin, and improved. A diagnosis of tuberculosis during the administration of infliximab therapy was very difficult because of atypical clinical symptoms and images e.g. the abscence of cavities or nodular shadows on her chest roentgenogram. To the best of our knowledge this case is the first report of tuberculosis associated with HPS, which was complicated by treatment with infliximab.
authors.forename: Tadahisa
authors.initials: T
authors.lastname: Numakura
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Matsuura
authors.forename: Hiroto
authors.initials: H
authors.lastname: Takiguchi
authors.forename: Yasuka
authors.initials: Y
authors.lastname: Hara
authors.forename: Koken
authors.initials: K
authors.lastname: Ameku
authors.forename: Horie
authors.initials: H
authors.lastname: Takashi
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects*; D006801:Humans; D000069285:Infliximab; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications / Q000209:etiology*; D008875:Middle Aged; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000209:etiology*
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab