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Shoureshi P, Ruiz J, Abdulzahir A, Bisch AL, Naddaf N, Gisel J. Tuberculosis-associated HLH in a patient with chronic kidney disease on haemodialysis. Oxf Med Case Reports 2020; 2020:omaa082. [PMID: 33133616 PMCID: PMC7583401 DOI: 10.1093/omcr/omaa082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/16/2020] [Accepted: 07/30/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Haemophagocytic lymphohistiocytosis (HLH) is a rare immunological disorder that is accompanied by a high mortality rate when the underlying aetiology is miliary tuberculosis. We report a case of tuberculosis (TB)-associated HLH in a haemodialysis patient, from a TB-endemic region, who missed two sessions of dialysis before developing the primary symptoms of HLH. The patient presented with non-specific findings including pancytopenia, coagulopathy and transaminitis. Computer-tomography imaging and microbiology from bronchoalveolar lavage evidenced miliary tuberculosis. Further testing revealed the TB-associated-HLH characteristic pattern of thrombocytosis, leukopenia, transaminitis, hyperferritinemia and elevated fibrinogen. The patient initially demonstrated improvement after initiation of anti-TB therapy. However, soon thereafter began to paradoxically deteriorate and then expire from apparent tuberculosis-immune reconstitution inflammatory syndrome. This case highlights the importance of early diagnosis and treatment, and consequently of the utility of diagnostic systems such as the HScore in cases of high clinical suspicion.
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Affiliation(s)
- Pouria Shoureshi
- Department of Internal Medicine, Orange Park Medical Center, Orange Park, FL, USA
| | - Johanna Ruiz
- Department of Internal Medicine, Orange Park Medical Center, Orange Park, FL, USA
| | - Ahmad Abdulzahir
- Department of Internal Medicine, Orange Park Medical Center, Orange Park, FL, USA
| | - Alexander L Bisch
- Medical student, Department of Internal Medicine, Edward Via College of Osteopathic Medicine- Carolinas, Spartanburg, SC, USA
| | - Naja Naddaf
- Core faculty, Department of Internal Medicine, Orange Park Medical Center, Orange Park, FL, USA
| | - Justin Gisel
- Core faculty, Department of Internal Medicine, Orange Park Medical Center, Orange Park, FL, USA
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