Objective To summarize the clinical manifestations,diagnosis and treatment of mycobacterium tuberculosis infection-associated hemophagocytic lymphohistiocytosis.
Methods One proven diagnosed case of mycobacterium tuberculosis infection-associated hemophagocytic lymphohistiocytosis was analyzed. Related publications of case reports and articles from Wanfang Data and China Hospital Knowledge Database were also reviewed.
Results A total of 15 cases were reported,in which 9 cases with complete clinical data. There were 7 males and 2 females,with a mean age of 31.2±15.83 years. The infected tissues were as follows:lung(6 cases),liver(2 cases),spleen(1 case),lymph node(2 cases),pleural(3 cases),peritoneum(2 cases),meninges(1 case),two or more sites infection(5 cases). The most clinical manifestations were fever,hepatosplenomegaly and enlarged lymph glands. The common laboratory abnormalities were liver dysfunction,pancytopaenia and haemophagocytosis in bone marrow. Treatment and outcomes:immunotherapy(5 cases,3 cases with intravenous immunoglobulin and 5 cases with steroid therapy) and anti-tuberculosis (14 cases). 3 cases were cured,6 cases improved and 6 died.
Conclusion There were no specific indexes of mycobacterium tuberculosis infection-associated hemophagocytic lymphohistiocytosis. Early proven diagnosis and administration of anti-tuberculosis and immunotherapy is essentials of effective therapy.
Citation:
Cheng Yusheng, Lu Zhiwei, Chen Liang, Chen Hu, Zhang Jun, Tu Xiongwen. Mycobacterium Tuberculosis Infection-associated Hemophagocytic Lymphohistiocytosis: A Case Report and Review of 15 Cases Reported in China. Chinese Journal of Respiratory and Critical Care Medicine, 2013, 12(2): 170-173. doi: 10.7507/1671-6205.2014041
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Creput C,Galicier L,Buyse S,et al.Understanding organ dysfunction in hemophagocytic lymphohistiocytosis.Intensive Care Med,2008,34:1177-1187.
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Henter JI,Horne A,Arico M,et al.HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis.Pediatr Blood Cancer,2007,48:124-131.
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Shea YF,Chan JF,Kwok WC,et al.Haemophagocytic lymphohistiocytosis: an uncommon clinical presentation of tuberculosis.Hong Kong Med J,2012,18:517-525.
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Brastianos PK,Swanson JW,Torbenson M,et al.Tuberculosis-associated haemophagocytic syndrome.Lancet Infect Dis,2006,6:447-454.
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Chang KC,Yew WW.Management of difficult multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis: update 2012.Respirology,2013,18:8-21.
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- 1. Creput C,Galicier L,Buyse S,et al.Understanding organ dysfunction in hemophagocytic lymphohistiocytosis.Intensive Care Med,2008,34:1177-1187.
- 2. Henter JI,Horne A,Arico M,et al.HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis.Pediatr Blood Cancer,2007,48:124-131.
- 3. Shea YF,Chan JF,Kwok WC,et al.Haemophagocytic lymphohistiocytosis: an uncommon clinical presentation of tuberculosis.Hong Kong Med J,2012,18:517-525.
- 4. Brastianos PK,Swanson JW,Torbenson M,et al.Tuberculosis-associated haemophagocytic syndrome.Lancet Infect Dis,2006,6:447-454.
- 5. Chang KC,Yew WW.Management of difficult multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis: update 2012.Respirology,2013,18:8-21.