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Tuberculosis-associated hemophagocytic lymphohistiocytosis with initial presentation of fever of unknown origin in a general hospital: An analysis of 8 clinical cases.

Abstract The study aimed to investigate the clinical features and prognoses of patients with tuberculosis (TB) who had secondary hemophagocytic lymphohistiocytosis (HLH).Patients first presenting with fever of unknown origin, who were ultimately diagnosed with TB-associated secondary HLH, were assessed retrospectively. We summarized and analyzed clinical manifestations, laboratory examinations, diagnoses, treatments, and prognoses of patients using clinical data, outpatient follow-up, and telephone follow-up in combination with literature review.Among patients admitted to the hospital with fever of unknown origin in the past 10 years, 371 patients were diagnosed with TB. Among them, 8 cases were diagnosed as tuberculosis-associated HLH (TB-HLH). The proportion of females among TB-HLH patients was higher than the proportion of females among TB patients. Within the same time period, 227 cases met the diagnostic criteria for HLH, among which TB-HLH patients accounted for 3.52% of the cases. None of the 8 TB-HLH patients had underlying diseases, and a majority of them had short symptom durations, rapid progression, along with multisystem and multiorgan dysfunctions. Their clinical manifestations were inconsistent with the typical clinical manifestations and imaging results characteristic of TB. Compared with patients with TB in our hospital during the same period, the 8 TB-HLH patients had a higher proportion of blood-disseminated TB and tuberculous meningitis. Apart from this, the hematological damage in these patients was higher than the common clinical manifestations of TB, and they also had a high proportion of respiratory failure. All 8 TB-HLH patients received antitubercular therapy, and 6 of them were also treated for HLH. However, their morbidity and mortality were significantly higher than that for reported cases of TB-HLH cases, both domestically and abroad, which may be attributed to the fever of unknown origin.Patients with TB-HLH had poor prognoses and no specific clinical manifestations. Therefore, cases of atypical TB and severe TB should be carefully monitored to achieve early diagnosis and early intervention.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28422850
OWN - NLM
STAT- In-Process
DA  - 20170419
LR  - 20170419
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 16
DP  - 2017 Apr
TI  - Tuberculosis-associated hemophagocytic lymphohistiocytosis with initial
      presentation of fever of unknown origin in a general hospital: An analysis of 8
      clinical cases.
PG  - e6575
LID - 10.1097/MD.0000000000006575 [doi]
AB  - The study aimed to investigate the clinical features and prognoses of patients
      with tuberculosis (TB) who had secondary hemophagocytic lymphohistiocytosis
      (HLH).Patients first presenting with fever of unknown origin, who were ultimately
      diagnosed with TB-associated secondary HLH, were assessed retrospectively. We
      summarized and analyzed clinical manifestations, laboratory examinations,
      diagnoses, treatments, and prognoses of patients using clinical data, outpatient 
      follow-up, and telephone follow-up in combination with literature review.Among
      patients admitted to the hospital with fever of unknown origin in the past 10
      years, 371 patients were diagnosed with TB. Among them, 8 cases were diagnosed as
      tuberculosis-associated HLH (TB-HLH). The proportion of females among TB-HLH
      patients was higher than the proportion of females among TB patients. Within the 
      same time period, 227 cases met the diagnostic criteria for HLH, among which
      TB-HLH patients accounted for 3.52% of the cases. None of the 8 TB-HLH patients
      had underlying diseases, and a majority of them had short symptom durations,
      rapid progression, along with multisystem and multiorgan dysfunctions. Their
      clinical manifestations were inconsistent with the typical clinical
      manifestations and imaging results characteristic of TB. Compared with patients
      with TB in our hospital during the same period, the 8 TB-HLH patients had a
      higher proportion of blood-disseminated TB and tuberculous meningitis. Apart from
      this, the hematological damage in these patients was higher than the common
      clinical manifestations of TB, and they also had a high proportion of respiratory
      failure. All 8 TB-HLH patients received antitubercular therapy, and 6 of them
      were also treated for HLH. However, their morbidity and mortality were
      significantly higher than that for reported cases of TB-HLH cases, both
      domestically and abroad, which may be attributed to the fever of unknown
      origin.Patients with TB-HLH had poor prognoses and no specific clinical
      manifestations. Therefore, cases of atypical TB and severe TB should be carefully
      monitored to achieve early diagnosis and early intervention.
FAU - Zhang, Yun
AU  - Zhang Y
AD  - Department of General Internal Medicine, Peking Union Medical College Hospital
      (PUMCH), Chinese Academy of Medical Science (CAMS), and Peking Union Medical
      College (PUMC), Beijing, China.
FAU - Liang, Guangyu
AU  - Liang G
FAU - Qin, Hongli
AU  - Qin H
FAU - Li, Yuanjie
AU  - Li Y
FAU - Zeng, Xuejun
AU  - Zeng X
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
EDAT- 2017/04/20 06:00
MHDA- 2017/04/20 06:00
CRDT- 2017/04/20 06:00
AID - 10.1097/MD.0000000000006575 [doi]
AID - 00005792-201704210-00031 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Apr;96(16):e6575. doi: 10.1097/MD.0000000000006575.

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