Miliary tuberculosis occurred after immunosuppressive drug in PNH patient with completely cured tuberculosis; a case report

• Published in: Annals of clinical microbiology and antimicrobials Vol. 11; no. 1; p. 12
• Main Authors: Lee, Jihyun, Gong, Soojung, Lee, Byounghoon, Lee, Soyoung, Lee, Jungae, Kim, Naeyu
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 03.05.2012; BioMed Central; BMC
• Subjects: Acute respiratory distress syndrome; Adult; Anemia; Antitubercular agents; Blood diseases; Bone marrow; Calcification; Case Report; Case reports; Chronic illnesses; Clinical medicine; Corticoids; Corticosteroids; Diagnosis; Drug therapy; Drugs; Dyspnea; Fever; Health aspects; Hemoglobin; Hemoglobinuria, Paroxysmal; Hemoglobinuria, Paroxysmal - complications; Hemoglobinuria, Paroxysmal - drug therapy; Hemolytic anemia; Humans; Hyperthermia; Immunosuppression; Immunosuppressive agents; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Immunotherapy; Infection; Infections; Internal medicine; Latent Tuberculosis - complications; Latent Tuberculosis - diagnostic imaging; Lung; Male; Medical imaging; Medicine; Miliary tuberculosis (TB); Mortality; Mycobacterium; Paroxysmal nocturnal hemoglobinuria; Patient outcomes; Patients; Prophylaxis; Radiography; Recurrence; Respiratory distress syndrome; Stem cells; Steroid hormones; Steroids; Thorax; thrombophilia; Thrombosis; Toxicity; Tuberculosis; Tuberculosis (TB) prophylaxis; Tuberculosis, Miliary - diagnostic imaging; Tuberculosis, Miliary - drug therapy; Tuberculosis, Miliary - etiology; Tuberculosis, Miliary - prevention & control; South Korea
• ISSN: 1476-0711; 1476-0711
• DOI: 10.1186/1476-0711-11-12

Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal disorder that presents with hemolytic anemia, marrow failure and thrombophilia. During acute attacks, corticosteroid can alleviate the hemolytic paroxysm, but the prolonged administration induces serious toxicity including immunosuppression. So American thoracic society (ATS) for tuberculosis (TB) recommends prophylactic anti-TB medication in patients with a long-term steroid therapy. However, in the patient who was treated for active TB in the past, there are no guidelines of the test for determining patients who have latent TB infection (LTBI) and no recommendations of TB prophylaxis if there is no evidence of reactivation at present. A 40-year-old male patient presented with fever and aggravated weakness for a week. He was diagnosed with PNH a month ago and took corticosteroid for 3 weeks. In the past, he was diagnosed with pulmonary TB and completely cured after treatment. According to guideline, he was not indicated with TB prophylaxis. However, he caught miliary TB, progressed to acute respiratory distress syndrome. We experience this embarrassing case, and emphasize the need to investigate multicentral TB prevalence and to make the guidelines of anti-TB medication in subgroups of hematologic diseases including PNH.