SHM Converge Scientific Abstract ePoster Gallery-Disseminated Tuberculosis Causing Hemophagocytic Lymphohistiocytosis

Pdf Summary

A 71-year-old man from Vietnam presented with several weeks of fatigue, lower-extremity bruising, and 20-lb unintentional weight loss. He was referred after a bone marrow biopsy showed hemophagocytosis and was started on anakinra. Workup revealed markedly elevated ferritin (15,855) and additional lab abnormalities concerning for severe systemic inflammation.<br /><br />Bone marrow biopsy demonstrated a hypercellular marrow with dyspoietic changes and hemophagocytosis of nucleated cells. It also showed numerous non-necrotizing granulomas with rare organisms detected on FITE stain, and no evidence of malignancy. These findings supported a diagnosis of disseminated tuberculosis with TB-associated hemophagocytic lymphohistiocytosis (HLH).<br /><br />He was treated with RIPE therapy for tuberculosis while continuing anakinra. The case highlights the importance of maintaining a broad differential diagnosis for HLH, especially in patients from TB-endemic regions. Extrapulmonary TB can present as a driver of HLH and should be considered when evaluating unexplained systemic inflammation, cytopenias, and marrow hemophagocytosis. Early recognition is critical because TB-HLH carries high mortality, and prompt treatment may improve outcomes. Bone marrow biopsy should also include microbiologic testing for Mycobacterium tuberculosis when HLH is suspected.

Asset Subtitle

Markus Guerrero

Meta Tag

Author List Markus Guerrero, Michelle Chiu

Category Clinical Vignettes

Concept Secondary hemophagocytic lymphohistiocytosis

Concept Tuberculosis

Concept Hemophagocytosis

Concept Mycobacterium tuberculosis

Concept Extrapulmonary Tuberculosis

Distinguished Non-Finalist

Presenter Organization Stanford Health Care

Presenting Author Markus Guerrero

Track Adult

Keywords

hemophagocytic lymphohistiocytosis

disseminated tuberculosis

bone marrow biopsy

hemophagocytosis

ferritin

systemic inflammation

granulomas

RIPE therapy

extrapulmonary tuberculosis

anakinra

Secondary hemophagocytic lymphohistiocytosis

Tuberculosis

Hemophagocytosis

Mycobacterium tuberculosis

Extrapulmonary Tuberculosis