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Hemophagocytic Lymphohistiocytosis: An Unusual Presentation of Tuberculosis in Hemodialysis Patients

Koulmane, Sindhura Laxminarayana L and Nagaraju, Shankar Prasad and Prabhu, Ravindra A and Parthasarathy, Rajeevalachana and Chethan, Manohar and Chari, Brahmaiah (2015) Hemophagocytic Lymphohistiocytosis: An Unusual Presentation of Tuberculosis in Hemodialysis Patients. Hemodialysis International, 19. pp. 1-19.

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Abstract

We report a series of three patients with end-stage renal disease on maintenance hemodialysis presenting with hemophagocytic lymphohistiocytosis (HLH) as an unusual manifestation of extrapulmonary tuberculosis. All three patients were middle-aged men. They presented with fever, pancytopenia, varying degrees of hepatosplenomegaly, abnormal liver function tests, coagulopathy,increased serum ferritin, and triglycerides. Tests for fever work-up were negative. Bone marrow examination revealed hemophagocytosis and caseating granuloma. Acid fast bacilli were demonstrated in two patients. The HLH-2004 diagnostic criteria suggested by the histiocytic society were followed to arrive at the diagnosis. All of them succumbed to death even before the definitive diagnosis could be made. We suggest that aggressive diagnostic work-up must be done when hemodialysis patients present with fever and pancytopenia. Priority should be toward early diagnosis and appropriate treatment to improve the prognosis.

Item Type: Article
Uncontrolled Keywords: Hemodialysis, Tuberculosis; Pancytopenia; Fever; Hemophagocytosis
Subjects: Medicine > MMMC Manipal > Pathology
Medicine > KMC Manipal > Nephrology
Medicine > KMC Manipal > Pathology
Depositing User: KMC Library
Date Deposited: 11 Apr 2016 08:51
Last Modified: 11 Apr 2016 08:51
URI: http://eprints.manipal.edu/id/eprint/145813

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