title: Tuberculosis-associated hemophagocytic lymphohistiocytosis in adolescent diagnosed by polymerase chain reaction.
abstract: We present a case of tuberculosis-associated hemophagocytic lymphohistiocytosis in a 14-year-old girl. The patient presented with weight loss, malaise, fatigue, prolonged fever, and generalized lymphadenopathy. Laboratory investigation revealed pancytopenia (white blood cells, 2,020 cells/µL; hemoglobin, 10.2 g/dL; platelets, 52,000 cells/µL), hypertriglyceridemia (229 mg/dL), and hyperferritinemia (1,420 ng/mL). Bone marrow biopsy showed a hypocellular bone marrow with a large numbers of histiocytes and marked hemophagocytosis; based on these findings, she was diagnosed with hemophagocytic lymphohistiocytosis. Polymerase chain reaction (PCR) with both the bone marrow aspiration and sputum samples revealed the presence of Mycobacterium tuberculosis. Antitubercular therapy with immune modulation therapy including dexamethasone and intravenous immunoglobulin was initiated. The results of all laboratory tests including bone marrow biopsy and PCR with both the bone marrow aspiration and sputum samples were normalized after treatment. Thus, early bone marrow biopsy and the use of techniques such as PCR can avoid delays in diagnosis and improve the survival rates of patients with tuberculosis-associated hemophagocytic lymphohistiocytosis.
authors.affiliation: Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Ju-Hee
authors.initials: JH
authors.lastname: Seo
authors.affiliation: Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Jun Ah
authors.initials: JA
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Dong Ho
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Joongbum
authors.initials: J
authors.lastname: Cho
authors.affiliation: Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Jung Sub
authors.initials: JS
authors.lastname: Lim
keywords: Adolescent; Hemophagocytic lymphohistiocytosis; Polymerase chain reaction; Tuberculosis