Disseminated tuberculosis complicated by intramuscular abscesses, meningoencephalitis, and hemophagocytic lymphohistiocytosis: a case report

• Published in: BMC infectious diseases Vol. 24; no. 1; pp. 747 - 6
• Main Authors: Liu, Huiting, Huang, Xiaoming, Jiao, Yang
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 29.07.2024; BioMed Central; BMC
• Subjects: Abscess; Abscess - drug therapy; Abscess - microbiology; Abscesses; Aged; Antibacterial agents; Antitubercular Agents - therapeutic use; Autoimmune diseases; Biopsy; Blood; Bone marrow; Care and treatment; Case Report; Catheters; Cerebrospinal fluid; Complications and side effects; Development and progression; Diagnosis; Disease; Disseminated tuberculosis infection; Dosage and administration; Fever; Health aspects; Health services; Hemoglobin; Hemophagocytic lymphohistiocytosis; Histiocytosis; Hospitalization; Hospitals; Humans; Hyperplasia; Hyperthermia; Infections; Lymphatic system; Lymphocytosis; Lymphohistiocytosis, Hemophagocytic - diagnosis; Lymphohistiocytosis, Hemophagocytic - drug therapy; Male; Medical diagnosis; Medical history; Medical imaging; Meningoencephalitis; Meningoencephalitis - complications; Meningoencephalitis - drug therapy; Meningoencephalitis - microbiology; Patients; Prognosis; Proteins; Psoas Abscess - drug therapy; Psoas Abscess - microbiology; Risk factors; Tomography; Tuberculosis; Tuberculosis - complications; Tuberculosis - drug therapy; Tuberculous meningitis; Ultrasonic imaging; Urinary retention; China; Hemophagocytic lymphohistiocytosis; Tuberculosis; Urinary retention; Disseminated tuberculosis infection; Tuberculous meningitis
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-024-09661-x

As disseminated extrapulmonary tuberculosis infection can involve multiple systems and result in atypical clinical manifestations that mimic other diseases, the diagnosis may be difficult, especially in elderly patients. Delaying treatment can adversely affect the prognosis. And to achieve better prognosis, early detection and diagnosis are necessary, as well as early initiation of comprehensive treatment. We present the case of a 78-year-old man with disseminated tuberculosis who developed the uncommon complication of urinary retention due to a psoas abscess, meningoencephalitis, and the rare secondary hemophagocytic lymphohistiocytosis syndrome. The patient achieved a favorable outcome following targeted therapy with antitubercular medications. This case highlights that disseminated extrapulmonary tuberculosis infection can present with a variety of manifestations, and may exhibit many rare and complex clinical presentations. Prompt and accurate diagnosis and treatment play a crucial role in improving prognosis for the patients with persistent fever.