An Unusual Triad of Hemophagocytic Syndrome, Lymphoma and Tuberculosis in a Non-HIV Patient

Abstract

Patient: Female, 58Final Diagnosis: Hemophagocytic syndrome • lymphoma and tuberculosis in a non-HIV patientSymptoms: Dizziness • feverMedication: —Clinical Procedure: —Specialty: Critical Care MedicineObjective:Rare co-existance of disease or pathologBackground:Lymphoma complicated with hemophagocytic syndrome and tuberculosis has been rarely reported. The clinical and radiological presentation of these potentially fatal conditions can be easily confused and there is a potential for misdiagnosis.Case Report:We present a 58-year-old Hispanic female who was admitted to the hospital with dizziness and fever. Her initial admission diagnosis was severe sepsis secondary to community acquired pneumonia. She was started on intravenous antibiotics. Due to mediastinal lymphadenopathy, lymphoma was considered as a differential diagnosis for which she underwent bronchoscopy and endobronchial ultrasound-guided sampling of her mediastinal lymph nodes. Lymph node aspirate was suggestive of lymphoma. Initial cultures were negative. Her clinical course was complicated with respiratory failure, cytopenia, and rapidly progressive cervical lymphadenopathy. The patient underwent cervical lymph node excision and bone marrow biopsy. The pathology of the lymph nodes confirmed T cell lymphoma, and bone marrow revealed hemophagocytosis. The patient was started on chemotherapy but she continued to deteriorate and died on day 20 of her hospital admission. Post-mortem results of cultures from a cervical lymph node biopsy and PCR were positive for Mycobacterium tuberculosis.Conclusions:We suggest an aggressive tissue diagnosis with staining for acid-fast bacilli for early diagnosis in patients presenting with hemophagocytic syndrome secondary to lymphoma as coexisting tuberculosis is a consideration. Tuberculosis re-activation should be considered in patients from an endemic region who present with lymphoma and a deteriorating clinical condition.

Incidence of and Risk Factors for Tuberculosis among Cancer Patients in Endemic Area: A Regional Cohort Study

“…Furthermore, interleukin 10 (IL-10), which is increased in patients with NHL, has been implicated in the reactivation of TB. The serum concentration of IL-10 has been found to be higher in patients with NHL, which may lead to decreased cell mediated immunity resulting in activation of latent TB (Hashmi et al, 2017) Hematopoietic cancer was related to TB disease developing. In this study, the cancer type with the highest proportion of patients receiving no treatment was hematopoietic cancer (59.1%; data not shown).…”

Simultaneous occurrence of invasive pulmonary aspergillosis and diffuse large B-cell lymphoma: case report and literature review

“…Only a few publications have reported this condition (Table 1) [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] (see Table 1. Reported cases of synchronous opportunistic infection and lymphoma).…”

Epilepsia partialis continua complicated by disseminated tuberculosis and hemophagocytic lymphohistiocytosis: a case report

“…This is due to dysregulation of activation and proliferation of macrophages in the bone marrow and other tissues. Primary (familial) HLH has a genetic etiology, whereas secondary HLH may be associated with malignancy, autoimmune/rheumatological disease (termed macrophage activation syndrome [MAS]) [17, 18], or infection [16, 17]. Although most infection-associated cases can be attributed to the Epstein-Barr virus, TB-associated HLH is also recognized [16].…”