Disseminated Tuberculosis Driving Secondary Haemophagocytic Lymphohistiocytosis Following Adalimumab and Treatment for Latent Tuberculosis.

IF 1 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL
British journal of hospital medicine Pub Date : 2025-03-26 Epub Date: 2025-03-05 DOI:10.12968/hmed.2024.0462
Timothy Seers, Helen Quah, Dalia Ludwig, Mahdad Noursadeghi, Michael Brown, David Aj Moore, Jessica J Manson
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引用次数: 0

Abstract

We describe the case of a 63-year-old man presenting with fevers, hyperferrintinaemia and pancytopaenia. He was known to have psoriatic arthritis, managed with adalimumab and methotrexate. Haemophagocytic lymphohistiocytosis (HLH) was diagnosed, and he was treated with intravenous anakinra whilst searching for an aetiology. Despite previous treatment for latent tuberculosis, he developed changes typical for miliary tuberculosis and was started on antituberculosis therapy; whole genome sequencing later demonstrated isoniazid monoresistance. This case demonstrates both the importance of recognising Mycobacterium tuberculosis as a trigger of HLH, and also the risk of latent tuberculosis treatment failure in the setting of monoresistance.

我们描述了一例 63 岁男子的病例,患者出现发热、高铁蛋白血症和泛酸血症。据了解,他患有银屑病关节炎,曾使用阿达木单抗和甲氨蝶呤治疗。他被诊断出患有嗜血细胞淋巴组织细胞增多症(HLH),在寻找病因的同时,他接受了静脉注射阿那金拉的治疗。尽管之前曾治疗过潜伏肺结核,但他还是出现了典型的粟粒性肺结核病变,并开始接受抗结核治疗;后来,全基因组测序显示他对异烟肼具有单耐药性。该病例表明,认识到结核分枝杆菌是诱发 HLH 的重要因素,以及在单耐药情况下潜伏结核病治疗失败的风险。
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来源期刊
British journal of hospital medicine
British journal of hospital medicine 医学-医学:内科
CiteScore
1.50
自引率
0.00%
发文量
176
审稿时长
4-8 weeks
期刊介绍: British Journal of Hospital Medicine was established in 1966, and is still true to its origins: a monthly, peer-reviewed, multidisciplinary review journal for hospital doctors and doctors in training. The journal publishes an authoritative mix of clinical reviews, education and training updates, quality improvement projects and case reports, and book reviews from recognized leaders in the profession. The Core Training for Doctors section provides clinical information in an easily accessible format for doctors in training. British Journal of Hospital Medicine is an invaluable resource for hospital doctors at all stages of their career. The journal is indexed on Medline, CINAHL, the Sociedad Iberoamericana de Información Científica and Scopus.
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