Korean J Pediatr.  2016 Jan;59(1):43-46. 10.3345/kjp.2016.59.1.43.

Tuberculosis-associated hemophagocytic lymphohistiocytosis in adolescent diagnosed by polymerase chain reaction

• Seo JH
• Lee JA
• Kim DH
• Cho J
• Lim JS

• KMID: 2152945
• DOI: http://doi.org/10.3345/kjp.2016.59.1.43

Abstract

We present a case of tuberculosis-associated hemophagocytic lymphohistiocytosis in a 14-year-old girl. The patient presented with weight loss, malaise, fatigue, prolonged fever, and generalized lymphadenopathy. Laboratory investigation revealed pancytopenia (white blood cells, 2,020 cells/microL; hemoglobin, 10.2 g/dL; platelets, 52,000 cells/microL), hypertriglyceridemia (229 mg/dL), and hyperferritinemia (1,420 ng/mL). Bone marrow biopsy showed a hypocellular bone marrow with a large numbers of histiocytes and marked hemophagocytosis; based on these findings, she was diagnosed with hemophagocytic lymphohistiocytosis. Polymerase chain reaction (PCR) with both the bone marrow aspiration and sputum samples revealed the presence of Mycobacterium tuberculosis. Antitubercular therapy with immune modulation therapy including dexamethasone and intravenous immunoglobulin was initiated. The results of all laboratory tests including bone marrow biopsy and PCR with both the bone marrow aspiration and sputum samples were normalized after treatment. Thus, early bone marrow biopsy and the use of techniques such as PCR can avoid delays in diagnosis and improve the survival rates of patients with tuberculosis-associated hemophagocytic lymphohistiocytosis.

Keyword

Hemophagocytic lymphohistiocytosis; Adolescent; Tuberculosis; Polymerase chain reaction

MeSH Terms

Adolescent*
Biopsy
Blood Cells
Bone Marrow
Dexamethasone
Diagnosis
Fatigue
Female
Fever
Histiocytes
Humans
Hypertriglyceridemia
Immunoglobulins
Lymphatic Diseases
Lymphohistiocytosis, Hemophagocytic*
Mycobacterium tuberculosis
Pancytopenia
Polymerase Chain Reaction*
Sputum
Survival Rate
Tuberculosis
Weight Loss
Dexamethasone
Immunoglobulins