Hemophagocytic Syndrome-Like Tuberculosis-Immune Reconstitution Inflammatory Syndrome After the Initiation of Hepatic Tuberculosis Treatment

• Published in: Curēus (Palo Alto, CA) Vol. 14; no. 5; p. e24644
• Main Authors: Nakamura, Serina, Muramae, Naokazu, Fujisawa, Akira, Yasuda, Noriaki, Okano, Mitsumasa, Mori, Kenta, Otsui, Kazunori, Sakaguchi, Kazuhiko
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 01.05.2022; Cureus
• Subjects: Abdomen; Allergy/Immunology; Anemia; Biopsy; Blood; Case reports; Cytomegalovirus; Drug dosages; Drug resistance; Fever; Hematology; Hemoglobin; HIV; Hospitalization; Human immunodeficiency virus; Infections; Infectious Disease; Laboratories; Liver; Lymphatic system; Medical imaging; Neutrophils; Pain; Patients; Proteins; Respiratory system; Steroids; Tomography; Tuberculosis; Viral infections; Nepal; hepatic tuberculosis; initial deterioration; tb-iris; hemophagocytic syndrome; steroid
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.24644

A 25-year-old Nepalese woman was referred to our hospital because of fever and intermittent abdominal pain with inguinal lymphadenopathy, which had lasted for several months. A liver biopsy of the positron emission tomography-positive lesion led to a diagnosis of hepatic tuberculosis. After the initiation of antituberculosis treatment, her symptoms resolved. However, 11 days after treatment initiation, chest and back pain, high-grade fever, and vomiting appeared and gradually worsened. She developed anemia and her serum ferritin level was elevated. Hemophagocytic syndrome due to the initial deterioration of tuberculosis was suspected and steroid therapy was initiated with the continuation of the antituberculosis drugs. Thereafter, the patient's condition improved remarkably.