Department of Tropical Medicine and Infectious Diseases, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
Institute for Microbiology, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
Infection. 2019 Feb;47(1):129-133. doi: 10.1007/s15010-018-1226-1. Epub 2018 Sep 26.
A 22-year-old HIV-negative man from Ghana was diagnosed with severe hemophagocytic lymphohistiocytosis (HLH) induced by multiorgan tuberculosis with peritoneal, hepatic, pericardial, myocardial, pleural, pulmonary, and bone manifestation. His body mass index was 12.9 m/kg. Bioptic material of a peritoneal biopsy grew M. tuberculosis, sensitive to all first-line antituberculous drugs. HLH resolved with antituberculous therapy, without additional anti-inflammatory therapy being given. The initial CT scan of his brain was normal. After 5 months of antituberculous treatment, he developed a paralysis of the left arm. A cerebral MRT showed ring-enhanced lesions. Blood cultures and lumbar puncture revealed Cryptococcus neoformans var. grubi. The HIV test was repeatedly negative. Antituberculous treatment was continued for a total of 9 months, and additional treatment with antifungal therapy was established. He recovered fully after 14 months of antifungal treatment.
一位 22 岁的 HIV 阴性加纳男子被诊断患有由多器官结核引起的严重噬血细胞性淋巴组织细胞增生症（HLH），伴有腹膜、肝、心包、心肌、胸膜、肺和骨表现。他的体重指数为 12.9m/kg。腹膜活检的活组织检查培养出结核分枝杆菌，对所有一线抗结核药物均敏感。抗结核治疗后 HLH 得到缓解，未给予额外的抗炎治疗。他的脑部初始 CT 扫描正常。抗结核治疗 5 个月后，他出现左侧手臂瘫痪。脑部 MRT 显示环形增强病变。血液培养和腰椎穿刺显示新型隐球菌变种。HIV 检测反复为阴性。抗结核治疗共持续 9 个月，并进行了抗真菌治疗。抗真菌治疗 14 个月后，他完全康复。
