A Case of Miliary Tuberculosis with Type 2 Diabetes Mellitus Complicated with Hemophagocytic Syndrome, Disseminated Intravascular Coagulation, Acute Respiratory Distress Syndrome and Acute Renal Failure

Abstract

We report a case of miliary tuberculosis survival with type 2 diabetes mellitus complicated by HPS, DIC, ARDS, and acute renal failure. A 61-year-old man with cold symptoms from January 1, 2009, and a fever of 38 to 39°C persisting despite oral antibiotics from January 6 was admitted on January 15 and found in laboratory tests to have abnormal liver function and hyperglycemia. His workup included ultrasound and computed tomography, results of which were normal. No causative pathogens were detected in serological tests or blood, sputum, and urine culture. Intravenous antibiotics administration was initiated, but his condition deteriorated with disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), and acute renal failure. He developed pancytopenia and increased serum ferritin. Hemophagocytic syndrome (HPS) was diagnosed in bone marrow biopsy findings on January 21. His fever decreased after steroid treatment started, but biliary enzymes continued elevated. Miliary tuberculosis was diagnosed with liver biopsy findings on January 27. After antituberculous therapy was started, his clinical situation gradually improved.