Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2022; 10(10): 3178-3187
Published online Apr 6, 2022. doi: 10.12998/wjcc.v10.i10.3178
Tuberculosis-associated hemophagocytic lymphohistiocytosis misdiagnosed as systemic lupus erythematosus: A case report
Wen-Ting Chen, Zhi-Cheng Liu, Meng-Shan Li, Ying Zhou, Shen-Ju Liang, Yi Yang
Wen-Ting Chen, Meng-Shan Li, Ying Zhou, Shen-Ju Liang, Yi Yang, Department of Rheumatology and Clinical Immunology, Army Medical Center, Army Medical University, Chongqing 400000, China
Zhi-Cheng Liu, Southwest Hospital, Army Medical University, Chongqing 400000, China
Author contributions: Chen WT and Liu ZC contributed equally to this work; Yang Y designed the study; and Chen WT drafted the manuscript; Li MS and Zhou Y collected the patient’s clinical data; Liang SJ photographed the histopathological examination; and Liu ZC revised the manuscript.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: There are no potential conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi Yang, PhD, Associate Chief Physician, Department of Rheumatology and Clinical Immunology, Army Medical Center, Army Medical University, No. 10 Changjiang Road, Daping, Yuzhong District, Chongqing 400000, China. yangyilyx709@163.com
Received: July 12, 2021
Peer-review started: July 12, 2021
First decision: September 28, 2021
Revised: October 10, 2021
Accepted: February 22, 2022
Article in press: February 22, 2022
Published online: April 6, 2022
Abstract
BACKGROUND

Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder with rapid progression and high mortality. HLH occurs mostly due to infection, malignant tumors, and immune disorders. Among infections that cause HLH, viral infections, especially Epstein-Barr virus infections, are common, whereas tuberculosis is rare. Tuberculosis-associated HLH has a wide range of serological and clinical manifestations that are similar to those of systemic lupus erythematosus (SLE).

CASE SUMMARY

This study describes a case of tuberculosis-associated HLH misdiagnosed as SLE because of antinuclear antibody (ANA), Smith (Sm) antibody and lupus anticoagulant positivity; leukopenia; thrombocytopenia; pleural effusion; decreased C3, quantitatively increased 24 h urinary protein and fever. The patient was initially treated with glucocorticoids, which resulted in peripheral blood cytopenia and symptom recurrence. Then, caseating granulomas and hemophagocytosis were observed in her bone marrow. She was successfully treated with conventional category 1 antituberculous drugs. In addition, we reviewed the literature on tuberculosis-associated HLH documented in PubMed, including all full-text articles published in English from December 2009 to December 2019, and summarized the key points, including the epidemiology, clinical manifestations, diagnosis, and treatment of tuberculosis-associated HLH and the differences of the present case from previous reports.

CONCLUSION

Tuberculosis should be considered in patients with fever or respiratory symptoms. Antituberculous drugs are important for treating tuberculosis-associated HLH.

Keywords: Hemophagocytic lymphohistiocytosis, Tuberculosis, Systemic lupus erythematosus, Misdiagnosis, Case report

Core Tip: Misdiagnosis often occurs in tuberculosis patients with hemophagocytic lymphohistiocytosis (HLH). This manuscript reports a case of tuberculosis-associated HLH misdiagnosed as systemic lupus erythematosus (SLE) and presents a literature review. This report is intended to increase the understanding of tuberculosis-associated HLH and emphasize that for the diagnosis of SLE. Tuberculosis should be considered in patients with fever or respiratory symptoms. Antituberculous drugs are important for treating tuberculosis-associated HLH.