An indeterminate result of QuantiFERON-TB Gold In-Tube for miliary tuberculosis due to a high level of IFN-γ production.
The QuantiFERON-TB Gold In-Tube(®) test has excellent specificity for Mycobacterium tuberculosis. However, diagnosis of miliary tuberculosis remains challenging, and the interpretation of QuantiFERON(®) results in immunocompromised individuals has not been fully established. Here, we present a patient with military tuberculosis who showed an indeterminate QuantiFERON(®) result. A 76-year-old male presented with fever and pancytopenia. Radiological tests did not show the classical miliary pattern. Acid-fast staining and polymerase chain reaction of several specimens were negative for M. tuberculosis. The QuantiFERON(®) responses were indeterminate on two separate tests, as interferon-γ (IFN-γ) concentration was high in the negative control. The patient did not respond to anti-microbiological therapy, and developed sepsis and disseminated intravascular coagulation, leading to lethal intracranial hemorrhage. An autopsy showed miliary tuberculosis and aplastic anemia. A literature review suggests a tendency towards indeterminate or false-negative QuantiFERON(®) results in immunocompromised individuals or patients with miliary tuberculosis due to low production of IFN-γ. Our patient, however, showed substantial amounts of IFN-γ despite lymphocytopenia, which has not been reported in the literature. The present case suggests that indeterminate results of QuantiFERON(®) should be interpreted with caution, as IFN-γ production in patients with miliary tuberculosis can vary significantly, even with sustained lymphocytopenia.
Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Sho
S
Hangai
Akihide
A
Yoshimi
Atsuko
A
Hosoi
Keisuke
K
Matsusaka
Motoshi
M
Ichikawa
Masashi
M
Fukayama
Mineo
M
Kurokawa
D000368:Aged; D001706:Biopsy; D006099:Granuloma / Q000473:pathology; D006801:Humans; D007371:Interferon-gamma / Q000096:biosynthesis*; D059425:Interferon-gamma Release Tests / Q000379:methods*; D008099:Liver / Q000473:pathology; D008168:Lung / Q000473:pathology; D008297:Male; D014057:Tomography, X-Ray Computed; D014391:Tuberculosis, Miliary / Q000175:diagnosis* / Q000378:metabolism*
D007371:Interferon-gamma