Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 10 , ISSUE 2 ( April, 2006 ) > List of Articles

CASE REPORT

Hemophagocytosis and miliary tuberculosis in a patient in the intensive care unit

F. Y. Khan, Zeinab Fawzy, Issar Siddiqui, Mohamed A. Yassin

Keywords : Hemophagocytosis, critically ill patient, miliary tuberculosis

Citation Information : Khan FY, Fawzy Z, Siddiqui I, Yassin MA. Hemophagocytosis and miliary tuberculosis in a patient in the intensive care unit. Indian J Crit Care Med 2006; 10 (2):112-114.

DOI: 10.4103/0972-5229.25924

License: CC BY-ND 3.0

Published Online: 01-07-2010

Copyright Statement:  Copyright © 2006; The Author(s).


Abstract

We report a 60-year-old woman who was admitted to our hospital with high-grade fever and dyspnea. Laboratory findings showed pancytopenia and examination of aspirated bone marrow showed mature histiocytes with marked hemophagocytosis. The patient′s condition continued to deteriorate despite adequate antibiotic coverage. Her respiratory condition worsened, so she was transferred to the ICU and ventilated. Transbroncheal biopsy was performed, which showed caseating granuloma suggesting pulmonary TB. Eight weeks later, bone marrow culture in Lowenstein media confirmed the presence of mycobacterium tuberculosis susceptible to INH, Rifampcine, pyrasinamide, ethambutol and streptomycin. Though anti-tuberculous therapy was started, she died after 28 days of hospitalization.


PDF Share
  1. Risdall RJ, McKenna RW, Nesbet ME, Krivit W, Balfour HH Jr, Simmons RL, et al. Virus associated hemophagocytic syndrome: A benign histiocytic proliferation distinct from malignant histiocytosis. Cancer 1979;44:993-1002.
  2. Baraldes MA, Domingo P, Gonzalez MJ, Aventin A, Coll P. Tuberculosis-associated hemophagocytic syndrome in patients with acquired immunodeficiency syndrome. Arch Intern Med 1998;158:194-5.
  3. Janka G, Imashuku S, Elinder G, Schneider M, Henter JI. Infection and malignancy associated hemophagocytic syndromes. Secondary hemophagocytic lymphohistiocytosis. Hematol Oncol Clin North Am 1998;12:435-44.
  4. Ishii E, Ueda I, Shirakawa R, Yamamoto K, Horiuchi H, Ohga S, et al. Genetic subtypes of familial hemophagocytic lymphohistiocytosis: Correlations with clinical features and cytotoxic T lymphocyte/natural killer cell functions. Blood 2005;105:3442-8.
  5. Henter JI, Arico M, Elinder G, Imashuku S, Janka G. Familial hemophagocytic lymphohistiocytosis. Primary hemophagocytic lymphohistiocytosis. Hematol Oncol Clin North Am 1998;12:417-33.
  6. Onishi R, Namiuchi S. Hemophagocytic syndrome in a patient with rheumatoid arthritis. Intern Med 1994;33:607-11.
  7. Wong KF, Hui PK, Chan JK, Chan YW, Ha SY. The acute lupus hemophagocytic syndrome. Ann Intern Med 1991;114:387-90.
  8. Kumakura S, Ishikura H, Munemasa S, Adachi T, Murakawa Y, Kobayashi S. Adult onset Still′s disease associated hemophagocytosis. J Rheumatol 1997;24:1645-8.
  9. Morris JA, Adamson AR, Holt PJ, Davson J. Still′s disease and the virus-associated haemophagocytic syndrome. Ann Rheumatol Dis 1985;44:349-53.
  10. Yasuda S, Tsutsumi A, Nakabayashi T, Horita T, Ichikawa K, Ieko M, et al. Haemophagocytic syndrome in a patient with dermatomyositis. Br J Rheumatol 1998;37:1357-8.
  11. Campo E, Condom E, Miro MJ, Cid MC, Romagosa V. Tuberculosis associated hemophagocytic syndrome: a systemic press. Cancer 1986;58:2640-5.
  12. Chang CS, Wang CH, Su IJ, Chen YC, Shen MC. Hematophagic histiocytosis: A clinicopathologic analysis of 23 cases with special reference to the association with peripheral T-cell lymphoma. J Formos Med Assoc 1994;93:421-8.
  13. Kadin ME, Kamoun M, Lamberg J. Erythrophagocytic T gamma lymphoma: A clinicopathologic entity resembling malignant histiocytosis. N Engl J Med 1981;304:648-53.
  14. Yao M, Cheng A, Su I. Clinicopathological spectrum of haemophagocytic syndrome in Epstein-Barr virus-associated peripheral T-cell lymphoma. Br J Haematol 1994;87:535-43.
  15. Kim JH, Langston AA, Gallis HA. Miliary tuberculosis: epidemiology, clinical manifestations, diagnosis and outcome [see comments]. Rev Infect Dis 1990;12:583-90.
  16. Grieco MH, Chmel H. Acute disseminated tuberculosis as a diagnostic problem. A clinical study based on twenty-eight cases. Am Rev Respir Dis 1974;109:554-60.
  17. Bobrowitz ID. Active tuberculosis undiagnosed until autopsy. Am J Med 1982;72:650-8.
  18. Jacques J, Sloan JM. The changing pattern of miliary tuberculosis. Thorax 1970;25:237-40.
  19. Reiner A, Spivak J. Hemophagocytic histiocytosis: A report of 23 new patients and a review of the literature. Medicine 1988;67:369-88.
  20. Janka G, Imashuku S, Elinder G, Schneider M, Henter JI. Infection and malignancy associated hemophagocytic syndromes. Secondary hemophagocytic lymphohistiocytosis. Hematol Oncol Clin North Am 1998;12:435-44.
  21. Kaito K, Kobayashi M, Katayama T, Otsubo H, Ogasawara Y, Sekita T, et al. Prognostic factors in hemophagocytic syndrome in adults: analysis of 34 cases. Eur J Haematol 1997;59:247-53.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.