Abstract:

Objective: To understand the clinical manifestations, laboratory findings, and treatment options of patients with hemophagocytic syndrome (HPS) induced by tuberculosis, and to improve understanding of this disease for early diagnosis and treatment. Methods: A retrospective analysis was performed on clinical data of 12 patients with tuberculosis complicated with HPS in Beijing Chest Hospital, Capital Medical University from January 2015 to January 2025. Demographic data, clinical features, laboratory results, treatment regimens, and prognosis were collected. Results: Among the 12 patients with tuberculosis complicated with HPS, only one case was over 65 years old (86-year-old). There were 11 cases of pulmonary tuberculosis, including 5 cases of miliary pulmonary tuberculosis (hematogenous disseminated type); 1 case of extrapulmonary tuberculosis (lymph node tuberculosis). All 12 patients presented with high fever (temperature>38.5 ℃) and elevated ferritin; 10 cases had varying degrees of cytopenia; 9 cases had splenomegaly, elevated plasma soluble CD25, and decreased NK cell activity, respectively; 6 cases showed hemophagocytosis in bone marrow smears; 4 cases had decreased fibrinogen; 1 case had elevated triglycerides; 7 cases had underlying tumors or immune diseases. All patients received active anti-tuberculosis treatment combined with HPS-specific therapy. Five patients died, with the time from HPS diagnosis to death ranging from 4 to 53 days (median, 22 days). Conclusion: Tuberculosis-induced HPS predominantly affects young and immunosuppressed populations, commonly with miliary pulmonary tuberculosis and all patients get high fever. Given its high mortality, aggressive treatment for HPS is necessary in conjunction with anti-tuberculosis therapy.

Key words: Tuberculosis, pulmonary, Hemophagocytic syndrome, Comorbidity, Disease attributes, Therapeutics, Prognosis