Abstract

HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS (HLH) AND TB: EARLY DIAGNOSIS PROVES CRUCIAL

Ratna Prasanth*, Asmah Moosa Abdulla Ahmed, Srivatsa Lokeshwaran, Sunil Kumar K., Navile Aditya Murali and Dr. Rini Susan Varghese

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Abstract

Background:- HLH is a serious disease due to exaggerated and flawed inflammatory response, which can be of two types, primary and secondary HLH. Mycobacterium tuberculosis induced HLH is quite rare and is linked with increased mortality of 50%.[2] An immunodeficient patient is presented in this case report who was diagnosed with M. tuberculosis infection associated HLH. Case Presentation:-A 40year old female presents to the out-patient department with fever of two months on and off and treated with multiple antibiotics. The patient was later diagnosed with pulmonary tuberculosis and was treated with anti-tuberculosis treatment. Subsequently the patient got admitted with fever, chills, nausea, excessive fatigue, oral ulcers and breathlessness. Her blood work up revealed she had developed pancytopenia. A bone marrow aspiration demonstrated features highly suggestive of HLH. The patient showed remarkable clinical improvement with the early identification and suitable treatment with oral corticosteroid and anti-tuberculosis regimen. This case calls for attention to this rare disorder, The need for team effort between specialists and high index of suspicion helps in clinching the diagnosis early and thereby reducing the mortality and morbidity. Conclusion:-This case reinforces the fact that physicians should consider HLH while treating a patient having an infection presenting with hyperferritinemia and pancytopenia while on treatment. Considering the increase in high mortality, early detection of disease and optimum treatment can give patients a favourable outcome.

Keywords: HLH, Tuberculosis, ATT, Dexamethasone, Mycobacterium infection, immune activation.