Korean J Intern Med.  2004 Mar;19(1):70-73.

Hemophagocytic Syndrome Associated with Bilateral Adrenal Gland Tuberculosis

• Shin BC
• Kim SW
• Ha SW
• Sohn JW
• Lee JM
• Kim NS

Abstract

We report a case of a patient who presented with hemophagocytic syndrome (HPS) and adrenal crisis associated with bilateral adrenal gland tuberculosis, and resulted in a poor outcome. A 50-year-old man was transferred to our hospital from a local clinic due to fever, weight loss, and bilateral adrenal masses. Laboratory findings showed leukopenia, mild anemia, and elevated lactate dehydrogenase. Computed tomography (CT) of the abdomen revealed bilateral adrenal masses and hepatosplenomegaly. CT-guided adrenal gland biopsy showed numerous epithelioid cells and infiltration with caseous necrosis consistent with tuberculosis. Bone marrow aspiration and biopsy showed significant hemophagocytosis without evidence of malignancy, hence HPS associated with bilateral adrenal tuberculosis was diagnosed. During anti-tuberculosis treatment the patient showed recurrent hypoglycemia and hypotension. Rapid ACTH stimulation test revealed adrenal insufficiency, and we added corticosteroid treatment. But pancytopenia, especially thrombocytopenia, persisted and repeated bone marrow aspiration showed continued hemophagocytosis. On treatment day 41 multiple organ failure occurred in the patient during anti-tuberculous treatment and steroid replacement.

Keyword

Histiocytosis; Tuberculosis; Adrenal glands

MeSH Terms

Adrenal Gland Diseases/*complications/drug therapy/radiography
Antitubercular Agents/therapeutic use
Histiocytosis, Non-Langerhans-Cell/*etiology/pathology
Human
Isoniazid/therapeutic use
Male
Middle Aged
Tomography, X-Ray Computed
Tuberculosis, Endocrine/*complications/drug therapy/radiography