Hashmi Hafiz Rizwan Talib, Mishra Rashmi, Niazi Masooma, Venkatram Sindhaghatta, Diaz-Fuentes Gilda
Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA.
Department of Pathology, Bronx Lebanon Hospital Center, Bronx, NY, USA.
Am J Case Rep. 2017 Jul 3;18:739-745. doi: 10.12659/ajcr.903990.
BACKGROUND Lymphoma complicated with hemophagocytic syndrome and tuberculosis has been rarely reported. The clinical and radiological presentation of these potentially fatal conditions can be easily confused and there is a potential for misdiagnosis. CASE REPORT We present a 58-year-old Hispanic female who was admitted to the hospital with dizziness and fever. Her initial admission diagnosis was severe sepsis secondary to community acquired pneumonia. She was started on intravenous antibiotics. Due to mediastinal lymphadenopathy, lymphoma was considered as a differential diagnosis for which she underwent bronchoscopy and endobronchial ultrasound-guided sampling of her mediastinal lymph nodes. Lymph node aspirate was suggestive of lymphoma. Initial cultures were negative. Her clinical course was complicated with respiratory failure, cytopenia, and rapidly progressive cervical lymphadenopathy. The patient underwent cervical lymph node excision and bone marrow biopsy. The pathology of the lymph nodes confirmed T cell lymphoma, and bone marrow revealed hemophagocytosis. The patient was started on chemotherapy but she continued to deteriorate and died on day 20 of her hospital admission. Post-mortem results of cultures from a cervical lymph node biopsy and PCR were positive for Mycobacterium tuberculosis. CONCLUSIONS We suggest an aggressive tissue diagnosis with staining for acid-fast bacilli for early diagnosis in patients presenting with hemophagocytic syndrome secondary to lymphoma as coexisting tuberculosis is a consideration. Tuberculosis re-activation should be considered in patients from an endemic region who present with lymphoma and a deteriorating clinical condition.
淋巴瘤合并噬血细胞综合征和结核病的报道很少。这些潜在致命疾病的临床和影像学表现很容易混淆，存在误诊的可能性。病例报告：我们报告一名58岁的西班牙裔女性，因头晕和发热入院。她最初的入院诊断是社区获得性肺炎继发严重脓毒症。开始静脉使用抗生素治疗。由于纵隔淋巴结肿大，考虑淋巴瘤为鉴别诊断，为此她接受了支气管镜检查和经支气管超声引导下纵隔淋巴结取样。淋巴结抽吸物提示为淋巴瘤。初始培养结果为阴性。她的临床病程并发呼吸衰竭、血细胞减少和快速进展的颈部淋巴结肿大。患者接受了颈部淋巴结切除和骨髓活检。淋巴结病理证实为T细胞淋巴瘤，骨髓显示噬血细胞现象。患者开始接受化疗，但病情继续恶化，入院第20天死亡。颈部淋巴结活检的培养物尸检结果和PCR检测显示结核分枝杆菌阳性。结论：我们建议对淋巴瘤继发噬血细胞综合征的患者进行积极的组织诊断，同时进行抗酸杆菌染色以早期诊断，因为需要考虑合并存在结核病的情况。对于来自结核病流行地区且患有淋巴瘤且临床病情恶化的患者，应考虑结核病复发。
