An Unusual Triad of Hemophagocytic Syndrome, Lymphoma and Tuberculosis in a Non-HIV Patient

摘要

Objective: Rare co-existance of disease or patholog Background: Lymphoma complicated with hemophagocytic syndrome and tuberculosis has been rarely reported. The clini- cal and radiological presentation of these potentially fatal conditions can be easily confusedm and there is a po- tential for misdiagnosis. Case Report: We present a 58-year-old Hispanic female who was admitted to the hospital with dizziness and fever. Her ini- tial 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 diag- nosis for which she underwent bronchoscopy and endobronchial ultrasound guided sampling of her mediasti- nal 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 lymphadenopa- thy. 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 pre- senting 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 lympho- ma and a deteriorating clinical condition.