粟粒性肺结核患者发生致命性噬血细胞性淋巴组织细胞增生症：一例报告
Fatal Hemophagocytic Lymphohistiocytosis in a Patient with Miliary Tuberculosis: a Case Report.
作者信息
Schippers Eva E, Creemers Sara G, Paltansing Sunita, van Zaanen Henk C T, Heijneman Joyce A M
机构信息
Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
Department of Internal Medicine and Hematology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
出版信息
SN Compr Clin Med. 2022;4(1):152. doi: 10.1007/s42399-022-01232-y. Epub 2022 Jul 14.
UNLABELLED
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome induced by cytotoxic T-cells. Mostly, HLH is secondary to infections, malignancies, or autoimmune disorders. HLH triggered by miliary tuberculosis is rare and mortality rates are high. We report a case of a 58-year-old, Caucasian patient admitted to the ICU with respiratory failure. After extensive tests, the diagnosis of HLH was made. Despite aggressive treatment with antibiotics, etoposide, anakinra, and tocilizumab, our patient succumbed to the illness after 18 days in the ICU. Postmortem, a diagnosis of miliary tuberculosis was made, despite negative PCR and culture of mycobacteria during clinical course. Our case demonstrates the challenges of early diagnosis of HLH and the importance of considering miliary tuberculosis as a possible underlying trigger.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s42399-022-01232-y.
摘要
噬血细胞性淋巴组织细胞增生症（HLH）是一种由细胞毒性T细胞诱导的危及生命的高炎症综合征。大多数情况下，HLH继发于感染、恶性肿瘤或自身免疫性疾病。粟粒性肺结核引发的HLH较为罕见，死亡率很高。我们报告一例58岁的白种人患者，因呼吸衰竭入住重症监护病房（ICU）。经过广泛检查，确诊为HLH。尽管使用抗生素、依托泊苷、阿那白滞素和托珠单抗进行了积极治疗，但我们的患者在ICU住院18天后仍因病死亡。尸检时，尽管临床过程中结核分枝杆菌的聚合酶链反应（PCR）和培养结果均为阴性，但仍诊断为粟粒性肺结核。我们的病例显示了HLH早期诊断的挑战以及将粟粒性肺结核视为可能的潜在触发因素的重要性。
补充信息
在线版本包含可在10.1007/s42399-022-01232-y获取的补充材料。
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