title: Hemophagocytic lymphohistiocytosis: An unusual presentation of tuberculosis in hemodialysis patients.
abstract: We report a series of three patients with end-stage renal disease on maintenance hemodialysis presenting with hemophagocytic lymphohistiocytosis (HLH) as an unusual manifestation of extrapulmonary tuberculosis. All three patients were middle-aged men. They presented with fever, pancytopenia, varying degrees of hepatosplenomegaly, abnormal liver function tests, coagulopathy, increased serum ferritin, and triglycerides. Tests for fever work-up were negative. Bone marrow examination revealed hemophagocytosis and caseating granuloma. Acid fast bacilli were demonstrated in two patients. The HLH-2004 diagnostic criteria suggested by the histiocytic society were followed to arrive at the diagnosis. All of them succumbed to death even before the definitive diagnosis could be made. We suggest that aggressive diagnostic work-up must be done when hemodialysis patients present with fever and pancytopenia. Priority should be toward early diagnosis and appropriate treatment to improve the prognosis.
authors.affiliation: Department of Pathology, Melaka Manipal Medical College, Manipal University, Udupi, Karnataka, India.
authors.forename: Sindhura L
authors.initials: SL
authors.lastname: Koulmane Laxminarayana
authors.affiliation: Department of Nephrology, Kasturba Medical College, Manipal University, Udupi, Karnataka, India.
authors.forename: Shankar P
authors.initials: SP
authors.lastname: Nagaraju
authors.affiliation: Department of Nephrology, Kasturba Medical College, Manipal University, Udupi, Karnataka, India.
authors.forename: Ravindra
authors.initials: R
authors.lastname: Prabhu Attur
authors.affiliation: Department of Pathology, Kasturba Medical College, Manipal University, Udupi, Karnataka, India.
authors.forename: Chethan
authors.initials: C
authors.lastname: Manohar
authors.affiliation: Department of Nephrology, Kasturba Medical College, Manipal University, Udupi, Karnataka, India.
authors.forename: Rajeevalochana
authors.initials: R
authors.lastname: Parthasarathy
authors.affiliation: Department of Pathology, Melaka Manipal Medical College, Manipal University, Udupi, Karnataka, India.
authors.forename: Brahmaiah
authors.initials: B
authors.lastname: Chari
mesh_terms: D000328:Adult; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D051359:Lymphohistiocytosis, Hemophagocytic / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D014376:Tuberculosis / Q000209:etiology*
keywords: Hemodialysis; fever; hemophagocytosis; pancytopenia; tuberculosis