NEJM: HLH-case reporting associated with diffuse TB

The patient was a 63-year-old man with chronic obstructive pulmonary disease (COPD) who went to the emergency department for fever, shortness of breath and confusionHe had a six-month history of fatigue, anorexia and a 6.8 kg weight loss and was treated for what was believed to be a worsening of COPD and pneumonia symptomsHe has no coughing, hemorrhage or recent travel reportsthe patient's temperature was 39.3 degrees C, the breathing rate was 32 beats per minute, and his oxygen saturation was 91% when he was 6LLaboratory examinations found platelet counts of 99,000/cm 3 mm (reference range 160,000 to 370000) and ferritin levels of 17189 ng/ml (reference range 22 to 275)Chest computed tomography scans found pulmonary turbidity, no noarity or cavitation in both lungsSputum's Gramstaine staining negative, sputum and blood bacterial culture is also negative, interferon radon release determination results are uncertainA bone marrow biopsy is required in view of the reduction of developed platelets, elevated levels of ferritin and refractive sepsisBiopsies show edagogic cell action (Figure A; Wright-Giemsa staining) and non-cheese-based granuloma with acid-resistant bacteria (Figure B, arrow; Ziehl-Neelsen staining)DNA probes with bone marrow puncture and sputum fluid were identified as mycobacterium tuberculosis and diagnosed as lymphocyte hyperplasia (HLH) of phage cells associated with dispersive tuberculosispatients were admitted to the intensive care unit and began anti-TB treatment, but died 55 days after treatment