CASE REPORT: “HEMOPHAGOCYTIC SYNDROME: A RARE INFECTIOUS COMPLICATION STRAIN” (Atena Editora)

Abstract

Objective: This report demonstrates an atypical and severe clinical condition that requires several differential diagnoses. Introduction: Hemophagocytic syndrome (hemophacocytic lymphohistiocytosis) is a rare and severe hyperinflammatory and hyperferritinemic immune response related to genetic disorders, lymphoproliferative diseases, collagenosis and infections, usually in immunosuppressed individuals. In rare cases of disseminated tuberculosis, this potentially fatal complication arises. Case report: Young, male patient, institutionalized, smoker, admitted due to sudden focal neurological deficit. History of chronic dry cough, weight loss, pleuritic pain and fever predominantly in the morning for 6 months, being treated for pneumonia, with partial response. Cranial tomography showed no changes, but brain MRI revealed nodular lesions with ring enhancement in the left nucleocapsular region. On chest tomography, multiple coalescing nodules distributed bilaterally, compatible with infectious granulomatous disease. Evolved with fever, respiratory distress, pancytopenia, lymphadenopathy, hepatosplenomegaly, liver dysfunction. Non-invasive ventilatory support and broad-spectrum antibiotics were started. Evaluated by hematology, which identified hemophagocytosis and granulomas with central necrosis in the anatomopathological study of the bone marrow. Subjected to bronchial lavage with positive BAAR research. Therefore, hemophagocytic syndrome was diagnosed as a critical complication of disseminated tuberculosis in an immunocompetent patient who survived after treatment.

Conclusion: Severe forms of tuberculosis such as the reported neurotuberculosis demonstrate a poor prognosis, especially in the face of a rare complication induced in a context of diagnostic delay and disease dissemination. Despite the low survival in the hemophagocytic syndrome, the patient obtained a therapeutic response to dexamethasone and the RIPE regimen, recovering functionality.