Hemophagocytic Syndrome as an Unusual Form of Presentation of Tuberculosis in a Hemodialysis Patient

Abstract

We present an unusual manifestation of tuberculosis in a patient on hemodialysis. A 73-year-old woman was admitted to our hospital with a picture of fever, dyspnea and weight loss. She had chronic renal failure and had started periodic hemodialysis 5 years before. Fifteen days after admission, she began with pancytopenia, abnormal liver function and coagulopathy. A bone marrow aspiration was made 1 week later showing macrophage elements with phagocytic activity. Eight weeks later, bone marrow culture in Lowenstein media confirmed the presence of tuberculosis. After the beginning of antituberculosis therapy, the laboratory disturbances disappeared and the clinical situation improved. We think that fever of unknown origin and pancytopenia in patients on maintenance hemodialysis must lead to an early bone marrow biopsy or aspiration since after the diagnosis a specific therapy can cure the disease.

Hypercalcaemia and haemophagocytic syndrome: rare concurrent presentations of disseminated tuberculosis in a dialysis patient

“…Amongst these, tuberculosis is a rare but recognised aetiology of haemophagocytic syndrome and is usually associated with high mortality rate (15,16). Chronic haemodialysis patients exhibiting extrapulmonary tuberculosis involving bone marrow with haemophagocytic syndrome have rarely been reported (17,18). In particular, our patient presented with hypercalcaemia from an unknown cause before the haemophagocytic syndrome developed.…”

Tuberculosis-Associated Hemophagocytic Lymphohistiocytosis: A Review of Current Literature

“…The number of criteria fulfilled by patients ranged from two to eight, with five being the most common. Table S3 provides an overview of each of the criteria for every patient in this study [ 3 , 4 , 5 , 6 , 7 , 10 , 13 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ...…”

Infection-associated hemophagocytic syndrome in a diabetic patient undergoing chronic hemodialysis

“…Infection-associated HPS has been reported with various infectious agents, including the Epstein-Barr virus, cytomegalovirus, gram-negative bacteria, tuberculosis, and fungi. [2][3][4][5][6] It sometimes occurs in patients in immunocompromised conditions, such as when using steroids or immunosuppressants.…”

“…Combined chemotherapy employing steroids, etoposide, and cyclosporine is recommended in virusassociated HPS, while bacteria-associated HPS may be resolved by treatment of the underlying infection. 1,[3][4][5][6] The effect of intravenous immunoglobulin and antiviral chemotherapy in the treatment of HPS has also been reported. Plasma exchange to improve hypercytokinemia is reportedly worthwhile for HPS refractory to conventional chemotherapy.…”

“…7 There have been two case reports of tuberculosisassociated HPS in patients undergoing hemodialysis. 3,4 One had a favorable clinical course after the administration of antituberculosis agents. In our patient, it is likely that Peptostreptococcus-induced sepsis and abscess formation in the left iliopsoas muscle were related to the onset of infection-associated hemophagocytosis.…”