UNASSIGNED: We report a 66-year-old hypertensive and diabetic male patient who presented with four days history of fever and abdominal pain. Denied history of cough and weight loss. Laboratory investigation showed: elevated ferritin, C-reactive protein, and triglyceride. Bone marrow examination showed > 50% hemophagocytosis (RBCs and platelets ingested by macrophages), positive acid-fast bacillus for Mycobacterium tuberculosis bacilli, and no evidence of malignancy. Complete blood count showed anemia and thrombocytopenia. The patient fulfilled six out of eight clinical criterions of the acquired Hemophagocytic lymphohistiocytosis (HLH). The patient was managed with anti-tuberculous medications with adjuvant steroid. On the subsequent days, the patient showed significant clinical improvement and discharged home. However, the patient passed away a week after home discharge.
UNASSIGNED: The present case highlights on the importance of early diagnosis and treatment of acquired HLH associated with tuberculous infection to improve the clinical outcome of the patient.
未经评估:我们报告了一名66岁的高血压和糖尿病男性患者,他有4天的发热和腹痛病史。否认咳嗽和体重减轻的病史。实验室调查显示:铁蛋白升高,C反应蛋白,和甘油三酯。骨髓检查显示>50%的噬血细胞(红细胞和血小板被巨噬细胞摄取),结核分枝杆菌的抗酸杆菌阳性,也没有恶性肿瘤的证据.全血细胞计数显示贫血和血小板减少。患者符合获得性噬血细胞性淋巴组织细胞增生症(HLH)的八项临床标准中的六项。患者接受了带有辅助类固醇的抗结核药物治疗。在随后的日子里,患者的临床症状明显改善,出院回家。然而,病人出院一周后去世。
UASSIGNED:本案例强调了早期诊断和治疗与结核感染相关的获得性HLH的重要性,以改善患者的临床预后。