A case of pancytopenia in a hemodialysis patient due to tuberculosis-associated hemophagocytic syndrome

Abstract

A 54-year-old patient on chronic hemodialysis was admitted to our hospital because of respiratory distress and pancytopenia. Laboratory data and radiographic examinations suggested acute lung injury and disseminated intravascular coagulation due to hemophagocytic syndrome (HPS). However, there were no causative pathogens detected by serological tests or cultures of blood, sputa and pleural effusion. Further testing by bone marrow examination showed hemophagocytotic cells, non-caseating granuloma formations and positive acidbacilli staining, which were highly suggestive of mycobacterium infection. The final diagnosis was determined as miliary tuberculosis by PCR and immune chromatography of bone marrow aspirate, and positive bronchoalveolar lavage fluid culture. Although tuberculosis still remains a life-threatening infectious disease for chronic hemodialysis patients, diagnosis is often difficult because atypical presentations such as extrapulmonary involvement are not uncommon. Tuberculosis should be considered early in the differential diagnosis of infectious aetiologies associated with HPS, since appropriate treatment can cure the disease.