Disseminated Mycobacterium tuberculosis: An Unusual Presentation with Associated Hemophagocytic Lymphohistiocytosis
Hemophagocytic lymphohistiocytosis (HLH) is a rare, potentially fatal, and systemic hyperinflammatory syndrome with exacerbated and uncontrolled activation of histiocytes and lymphocytes against mature cells. Secondary HLH can occur in association with a myriad of underlying infections or malignanci...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-01-01
|
| Series: | Case Reports in Hematology |
| Online Access: | http://dx.doi.org/10.1155/2022/4669025 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850225817833963520 |
|---|---|
| author | Ahmed Arfa Nivin Omar Kulsum Bano Natasha M. Savage |
| author_facet | Ahmed Arfa Nivin Omar Kulsum Bano Natasha M. Savage |
| author_sort | Ahmed Arfa |
| collection | DOAJ |
| description | Hemophagocytic lymphohistiocytosis (HLH) is a rare, potentially fatal, and systemic hyperinflammatory syndrome with exacerbated and uncontrolled activation of histiocytes and lymphocytes against mature cells. Secondary HLH can occur in association with a myriad of underlying infections or malignancies. Our patient is a 38-year-old male prisoner with poorly controlled diabetes and no known other medical conditions. He was referred to our emergency department with three-week history of worsening malaise, weight loss, fever, bruising, and shortness of breath; imaging showed pneumomediastinum, lung nodule, and adrenal mass. Biopsy of the lung nodule revealed acid-fast bacilli. Furthermore, bone marrow biopsy showed foci of necrosis with associated acid-fast bacilli and hemophagocytosis highlighted by CD163 stain; consequently, secondary HLH was suggested. Hence, lab results were reviewed and found to satisfy five of the eight secondary HLH criteria. Moreover, ferritin was >10,000 ng/ml, which has been suggested to be highly suspicious for HLH. The patient was started on anti-MAC therapy. Unfortunately, the patient’s status declined rapidly; he developed multi-organ failure and succumbed to disease. Later, his culture confirmed Mycobacterium tuberculosis. In conclusion, we presented a rare and challenging case of secondary HLH associated with disseminated Mycobacterium tuberculosis. A high index of suspicion is required for early diagnosis and treatment, and pathologists should be aware of Mycobacterium tuberculosis’ association with secondary HLH. |
| format | Article |
| id | doaj-art-5b711fcb8f3b49418dd37ce23cdee32b |
| institution | OA Journals |
| issn | 2090-6579 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Hematology |
| spelling | doaj-art-5b711fcb8f3b49418dd37ce23cdee32b2025-08-20T02:05:13ZengWileyCase Reports in Hematology2090-65792022-01-01202210.1155/2022/4669025Disseminated Mycobacterium tuberculosis: An Unusual Presentation with Associated Hemophagocytic LymphohistiocytosisAhmed Arfa0Nivin Omar1Kulsum Bano2Natasha M. Savage3Department of PathologyDepartment of PathologyDepartment of PathologyDepartment of PathologyHemophagocytic lymphohistiocytosis (HLH) is a rare, potentially fatal, and systemic hyperinflammatory syndrome with exacerbated and uncontrolled activation of histiocytes and lymphocytes against mature cells. Secondary HLH can occur in association with a myriad of underlying infections or malignancies. Our patient is a 38-year-old male prisoner with poorly controlled diabetes and no known other medical conditions. He was referred to our emergency department with three-week history of worsening malaise, weight loss, fever, bruising, and shortness of breath; imaging showed pneumomediastinum, lung nodule, and adrenal mass. Biopsy of the lung nodule revealed acid-fast bacilli. Furthermore, bone marrow biopsy showed foci of necrosis with associated acid-fast bacilli and hemophagocytosis highlighted by CD163 stain; consequently, secondary HLH was suggested. Hence, lab results were reviewed and found to satisfy five of the eight secondary HLH criteria. Moreover, ferritin was >10,000 ng/ml, which has been suggested to be highly suspicious for HLH. The patient was started on anti-MAC therapy. Unfortunately, the patient’s status declined rapidly; he developed multi-organ failure and succumbed to disease. Later, his culture confirmed Mycobacterium tuberculosis. In conclusion, we presented a rare and challenging case of secondary HLH associated with disseminated Mycobacterium tuberculosis. A high index of suspicion is required for early diagnosis and treatment, and pathologists should be aware of Mycobacterium tuberculosis’ association with secondary HLH.http://dx.doi.org/10.1155/2022/4669025 |
| spellingShingle | Ahmed Arfa Nivin Omar Kulsum Bano Natasha M. Savage Disseminated Mycobacterium tuberculosis: An Unusual Presentation with Associated Hemophagocytic Lymphohistiocytosis Case Reports in Hematology |
| title | Disseminated Mycobacterium tuberculosis: An Unusual Presentation with Associated Hemophagocytic Lymphohistiocytosis |
| title_full | Disseminated Mycobacterium tuberculosis: An Unusual Presentation with Associated Hemophagocytic Lymphohistiocytosis |
| title_fullStr | Disseminated Mycobacterium tuberculosis: An Unusual Presentation with Associated Hemophagocytic Lymphohistiocytosis |
| title_full_unstemmed | Disseminated Mycobacterium tuberculosis: An Unusual Presentation with Associated Hemophagocytic Lymphohistiocytosis |
| title_short | Disseminated Mycobacterium tuberculosis: An Unusual Presentation with Associated Hemophagocytic Lymphohistiocytosis |
| title_sort | disseminated mycobacterium tuberculosis an unusual presentation with associated hemophagocytic lymphohistiocytosis |
| url | http://dx.doi.org/10.1155/2022/4669025 |
| work_keys_str_mv | AT ahmedarfa disseminatedmycobacteriumtuberculosisanunusualpresentationwithassociatedhemophagocyticlymphohistiocytosis AT nivinomar disseminatedmycobacteriumtuberculosisanunusualpresentationwithassociatedhemophagocyticlymphohistiocytosis AT kulsumbano disseminatedmycobacteriumtuberculosisanunusualpresentationwithassociatedhemophagocyticlymphohistiocytosis AT natashamsavage disseminatedmycobacteriumtuberculosisanunusualpresentationwithassociatedhemophagocyticlymphohistiocytosis |