Secondary hemophagocytic lymphohistiocytosis: an unusual complication in disseminated Mycobacterium tuberculosis

Tuberculosis-associated hemophagocytic lymphohistiocytosis (TB-HLH) is a rare and life-threatening complication of tuberculosis infection. Early recognition and treatment of TB-HLH is crucial for improving outcomes. Treatment typically involves a combination of antituberculosis therapy and immunosup...

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Published inClinical medicine (London, England) Vol. 23; no. 4; p. 414
Main Authors Ing, Shan Kai, Lee, Grace Wan Chieng, Leong, Tze Shin, Lee, Yih Hoong, Lau, George Yew Liang, Yusof, Nur Nazihah, Chang, Andrew Kean Wei, Wong, Kelly Kee Yung
Format Journal Article
LanguageEnglish
Published England 01.07.2023
Subjects
Diagnosis, Differential
Humans
Lymphohistiocytosis, Hemophagocytic - diagnosis
Lymphohistiocytosis, Hemophagocytic - etiology
Male
Middle Aged
Mycobacterium tuberculosis
Splenic Diseases
Tuberculosis - complications
Tuberculosis - diagnosis
Tuberculosis - drug therapy
dexamethasone
tuberculosis
hemophagocytic lymphohistiocytosis
intravenous immunoglobulin
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Summary:Tuberculosis-associated hemophagocytic lymphohistiocytosis (TB-HLH) is a rare and life-threatening complication of tuberculosis infection. Early recognition and treatment of TB-HLH is crucial for improving outcomes. Treatment typically involves a combination of antituberculosis therapy and immunosuppressive therapy to control the immune system's overreaction. In this report, we present the case of a 53-year-old ambulance driver who was diagnosed with TB-HLH. His CT scan revealed splenic abscesses, hepatomegaly and bilateral lung consolidation. He subsequently developed multiorgan failure, including acute respiratory distress syndrome (ARDS), transaminitis and bone marrow dysfunction. The clinical course and simultaneous increase in serum ferritin raised the suspicion of HLH. His Hscore was 254, indicating a high probability of hemophagocytic syndrome. TB diagnosis was confirmed by positive endotracheal TB GeneXpert and bone marrow aspiration (BMA) which detected acid-fast bacilli organisms. The patient was promptly started on anti-TB, dexamethasone and IVIG. The patient responded well to treatment and made a full recovery without any lasting complications. This case highlights the importance of promptly recognising HLH and identifying the underlying cause. In critically ill patients, it is crucial not to delay HLH-specific treatment while working up for differential diagnosis.
ISSN:1473-4893