Tuberculosis-associated HLH in a patient with chronic kidney disease on haemodialysis
Orange Park Medical Center
Haematology, Infectious diseases and tropical medicine, Nephrology, Haemophagocytic lymphohistiocytosis, Tuberculosis
Bacterial Infections and Mycoses | Hematology | Immune System Diseases | Infectious Disease | Nephrology
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.
Publisher or Conference
Oxford Medical Case Reports
Shoureshi P, Ruiz J, Abdulzahir A, Bisch A, et al. Tuberculosis-associated HLH in a patient with chronic kidney disease on haemodialysis. Oxf Med Case Reports. 2020 October;2020(10):0maa082. https://doi.org/10.1093/omcr/omaa082