Undiagnosed tuberculosis associated with hemophagocytic lymphohistiocytosis due to improper use of corticosteroid
Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening hematologic disease segregated into familial (primary) and acquired (secondary) subtypes. Hyperinflammation and HLH occur when the immune system fails to clear activated macrophages and histiocytes. Infections, ma...
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The Journal of Infection in Developing Countries
2023-11-01
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| Series: | Journal of Infection in Developing Countries |
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| Online Access: | https://jidc.org/index.php/journal/article/view/17303 |
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| author | Hadi Allahverdi Nazhand Shahram Sabeti Farid Javandoust Gharehbagh Ronak Nalini Abdolreza Babamahmoodi Maryam Marahemi Elmira Mahmoudi Chalmiani Legha Lotfollahi Ilad Alavi Darazam |
| author_facet | Hadi Allahverdi Nazhand Shahram Sabeti Farid Javandoust Gharehbagh Ronak Nalini Abdolreza Babamahmoodi Maryam Marahemi Elmira Mahmoudi Chalmiani Legha Lotfollahi Ilad Alavi Darazam |
| author_sort | Hadi Allahverdi Nazhand |
| collection | DOAJ |
| description |
Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening hematologic disease segregated into familial (primary) and acquired (secondary) subtypes. Hyperinflammation and HLH occur when the immune system fails to clear activated macrophages and histiocytes. Infections, malignancies, and rheumatologic disorders are the major triggers leading to HLH. Miliary tuberculosis is a serious disease with a lymphohematogenous spread of Mycobacterium tuberculosis, which is known to be one of the causative agents of HLH. Miliary tuberculosis and HLH have atypical presentations which are similar to routine diseases. Hence, physicians may face challenges to diagnose and treat these complications.
Case report: We report the case of a 60-year-old man with a history of prolonged fever, shortness of breath, jaundice, altered mental status, undiagnosed lower back pain, and overuse of parenteral betamethasone. Miliary tuberculosis was diagnosed by diffuse, vague random micronodules in both lungs and positive acid-fast bacilli in bronchoalveolar lavage and bone marrow aspiration and biopsy. Moreover, compatible presentation and pancytopenia, hypertriglyceridemia, high serum level of ferritin and fibrinogen-derived products, and evidence of hemophagocytosis on bone marrow aspirate led to the diagnosis of HLH. Unfortunately, despite nearly two months of an anti-tuberculosis regimen (standard and salvage) and eight doses of etoposide, he eventually passed away after clinical improvement.
Conclusions: Irrational and indiscriminate use of glucocorticoids can be a devastating cause of the spread of tuberculosis and its rare complications, such as HLH.
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| format | Article |
| id | doaj-art-cb4d80d4c8a543fca3074a2478daccbd |
| institution | Kabale University |
| issn | 1972-2680 |
| language | English |
| publishDate | 2023-11-01 |
| publisher | The Journal of Infection in Developing Countries |
| record_format | Article |
| series | Journal of Infection in Developing Countries |
| spelling | doaj-art-cb4d80d4c8a543fca3074a2478daccbd2025-08-20T03:52:39ZengThe Journal of Infection in Developing CountriesJournal of Infection in Developing Countries1972-26802023-11-01171110.3855/jidc.17303Undiagnosed tuberculosis associated with hemophagocytic lymphohistiocytosis due to improper use of corticosteroidHadi Allahverdi Nazhand0Shahram Sabeti1Farid Javandoust Gharehbagh2Ronak Nalini3Abdolreza Babamahmoodi4Maryam Marahemi5Elmira Mahmoudi Chalmiani6Legha Lotfollahi7Ilad Alavi Darazam8Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IranPathology Ward, Loghman Hakim hospital, Shahid Beheshti University of Medical Sciences, Tehran, IranInfectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of Hematology and Oncology, Shahid Beheshti University of Medical Sciences, Tehran, IranInfectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IranInfectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IranInfectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of Nephrology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IranInfectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening hematologic disease segregated into familial (primary) and acquired (secondary) subtypes. Hyperinflammation and HLH occur when the immune system fails to clear activated macrophages and histiocytes. Infections, malignancies, and rheumatologic disorders are the major triggers leading to HLH. Miliary tuberculosis is a serious disease with a lymphohematogenous spread of Mycobacterium tuberculosis, which is known to be one of the causative agents of HLH. Miliary tuberculosis and HLH have atypical presentations which are similar to routine diseases. Hence, physicians may face challenges to diagnose and treat these complications. Case report: We report the case of a 60-year-old man with a history of prolonged fever, shortness of breath, jaundice, altered mental status, undiagnosed lower back pain, and overuse of parenteral betamethasone. Miliary tuberculosis was diagnosed by diffuse, vague random micronodules in both lungs and positive acid-fast bacilli in bronchoalveolar lavage and bone marrow aspiration and biopsy. Moreover, compatible presentation and pancytopenia, hypertriglyceridemia, high serum level of ferritin and fibrinogen-derived products, and evidence of hemophagocytosis on bone marrow aspirate led to the diagnosis of HLH. Unfortunately, despite nearly two months of an anti-tuberculosis regimen (standard and salvage) and eight doses of etoposide, he eventually passed away after clinical improvement. Conclusions: Irrational and indiscriminate use of glucocorticoids can be a devastating cause of the spread of tuberculosis and its rare complications, such as HLH. https://jidc.org/index.php/journal/article/view/17303hemophagocytic lymphohistiocytosismiliary tuberculosisMycobacterium tuberculosistreatment |
| spellingShingle | Hadi Allahverdi Nazhand Shahram Sabeti Farid Javandoust Gharehbagh Ronak Nalini Abdolreza Babamahmoodi Maryam Marahemi Elmira Mahmoudi Chalmiani Legha Lotfollahi Ilad Alavi Darazam Undiagnosed tuberculosis associated with hemophagocytic lymphohistiocytosis due to improper use of corticosteroid Journal of Infection in Developing Countries hemophagocytic lymphohistiocytosis miliary tuberculosis Mycobacterium tuberculosis treatment |
| title | Undiagnosed tuberculosis associated with hemophagocytic lymphohistiocytosis due to improper use of corticosteroid |
| title_full | Undiagnosed tuberculosis associated with hemophagocytic lymphohistiocytosis due to improper use of corticosteroid |
| title_fullStr | Undiagnosed tuberculosis associated with hemophagocytic lymphohistiocytosis due to improper use of corticosteroid |
| title_full_unstemmed | Undiagnosed tuberculosis associated with hemophagocytic lymphohistiocytosis due to improper use of corticosteroid |
| title_short | Undiagnosed tuberculosis associated with hemophagocytic lymphohistiocytosis due to improper use of corticosteroid |
| title_sort | undiagnosed tuberculosis associated with hemophagocytic lymphohistiocytosis due to improper use of corticosteroid |
| topic | hemophagocytic lymphohistiocytosis miliary tuberculosis Mycobacterium tuberculosis treatment |
| url | https://jidc.org/index.php/journal/article/view/17303 |
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