Hemophagocytic Syndrome as an Initial Presentation of Miliary Tuberculosis Without Pulmonary Findings

Dilber, Embiya; Erduran, Erol; Kalyoncu, Mukaddes; Aynaci, Fatma Müjgan; Ökten, Ayşenur; Ahmetoğlu, Ali

doi:10.1080/00365540210147840

Cited by 27 publications

(21 citation statements)

References 11 publications

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“…Disseminated tuberculosis and histoplasmosis may cause hemophagocytosis with fever of unknown origin [21,22]. In our series, four patients with FUO also had hemophagocytotic syndrome.…”

Section: Discussionmentioning

confidence: 92%

Fever of Unknown Origin in Taiwan

et al. 2006

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“…Disseminated tuberculosis and histoplasmosis may cause hemophagocytosis with fever of unknown origin [21,22]. In our series, four patients with FUO also had hemophagocytotic syndrome.…”

Section: Discussionmentioning

confidence: 92%

Fever of Unknown Origin in Taiwan

et al. 2006

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“…Further, it is possible that these illnesses may, in turn, trigger MAS. It may also be noted that some of these infectious disorders can themselves cause infectionassociated hemophagocytosis (IAHS) [13][14][15][16]. In a developing country setup, differentiating MAS in association with SOJIA from other reactive hemophagocytosis like IAHS is important, because treatment of the two conditions is along different lines.…”

Section: Discussionmentioning

confidence: 99%

Macrophage activation syndrome in children with systemic onset juvenile idiopathic arthritis: clinical experience from northwest India

et al. 2011

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The objective of this study is to describe the clinical and laboratory features of macrophage activation syndrome (MAS) in systemic onset juvenile idiopathic arthritis (SOJIA) at a tertiary care center in northwest India. Review of medical records of all children with SOJIA admitted during the period January 1995-December 2008 in Pediatric Allergy and Immunology Unit, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, was done. Six patients (5 boys and 1 girl) with SOJIA and MAS were identified. Mean age at time of disease onset was 6.5 years. MAS was the presenting manifestation of SOJIA in 4 patients. Clinical manifestations included fever (6/6), clinical shock (6/6), encephalopathy (5/6), generalized lymphadenopathy (4/6), hepatosplenomegaly (3/6), jaundice and abdominal tenderness (3/6), cardiac involvement (3/6), and meningeal irritation (2/6). Laboratory findings at onset of MAS included decreasing total leukocyte and platelet counts, coagulopathy, elevated transaminases, hyponatremia, and lipid abnormalities. Hemophagocytosis was demonstrable in the bone marrow in 4 patients and in the lymph node in 1. For treatment, we used intravenous methylprednisolone (4/6), oral prednisolone (2/6), and intravenous immunoglobulin (2/6). Outcome was favorable in all patients except one who died of rapidly progressive disease. This paper describes the experience of JIA-related macrophage activation syndrome in a tertiary Indian center. We have shown that MAS can be the early presenting manifestation of evolving SOJIA. Early diagnosis and aggressive management can have a significant impact on the mortality associated with this syndrome. We stress on the role of glucocorticoids in the management of this condition and believe that glucocorticoids have a far more important role in the management of this condition than what has been previously reported.

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“…También debe tenerse en cuenta que algunos pacientes con tuberculosis grave y diseminada pueden presentar anemia, leucopenia, trombocitopenia o pancitopenia, que se resuelven con el tratamiento antituberculoso. 8 La ferritina puede elevarse en procesos inflamatorios agudos o crónicos. Visser et al, 9 observaron hiperferritininemia en pacientes con tuberculosis diseminada, especialmente en VIH positivos.…”

Section: Discussionunclassified