Indian Journal of Hematology and Blood Transfusion

, Volume 28, Issue 3, pp 178–180 | Cite as

Childhood Tuberculosis Presenting with Haemophagocytic Syndrome

  • Tarun Verma
  • Sameer Aggarwal
Case Report


Haemophagocytic syndrome is a life threatening complication of systemic infection resulting from an exaggerated immune response to a triggering agent. Prompt recognition and treatment of this disorder can abrogate otherwise high fatality associated with this disorder. A 2 year old girl presented with acute enteritis, developed prolonged fever and organomegaly complicated by multi-organ failure. She fulfilled the diagnostic criteria for haemophagocytic lymphohistiocytosis including bone marrow evidence of haemophagocytosis. In addition she had serological evidence of tubercular infection as well as a positive family history of tuberculosis. She responded rapidly to immunosuppressive therapy and anti-tubercular therapy. Our case illustrates the association of haemophagocytic syndrome with tuberculosis as well as the favourable response obtained with prompt diagnosis and treatment.


Visceral Leishmaniasis Leishmaniasis Macrophage Activation Syndrome Childhood Tuberculosis High Grade Fever 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors acknowledge the efforts of the nursing and laboratory staff in ensuring a successful outcome of the case.

Conflict of interest



  1. 1.
    Henter JI, Horne A, Arico M et al (2007) HLH-2004: diagnostic and therapeutic guidelines for haemophagocytic lymphohistiocytosis. Paed Blood Cancer 48:124–131CrossRefGoogle Scholar
  2. 2.
    Imashuku S (2000) Advances in the management of haemophagocytic lymphohistiocytosis. Int J Haematol 72:1–11Google Scholar
  3. 3.
    Imashuku S, Hibi S, Todo S et al (1997) Haemophagocytic lymphohistiocytosis in infancy and childhood. J Paediatr 130:352–357CrossRefGoogle Scholar
  4. 4.
    Arico M, Janka G, Fischer M et al (1996) Haemophagocytic lymphohistiocytosis: diagnosis, treatment and prognostic factors. Report of 122 children from the international registry. Leukemia 10:197–203PubMedGoogle Scholar
  5. 5.
    Fishman DN (2000) Haemophagocytic syndromes and infection. Emerg Infect Dis 6(6):601–608CrossRefGoogle Scholar
  6. 6.
    Avila-Aguero ML, Camacho-Badilla K, Canas-Coto A, et al. (2003) Haemophagoctyic syndrome in children—a thirty case experience. Intersci Conf Antimicrob Agents Chemother. Abstract no G-1556, 43rd; Sep 2003Google Scholar
  7. 7.
    Lokesh B, Boctor D, Davey A (2004) Cytomegalovrus associated haemophagocytic syndrome in a child with Crohn’s disease receiving azathioprine. J Paediatr Gastroenterol Nutrition 39:418–421CrossRefGoogle Scholar
  8. 8.
    Agarwal S, Narayan S, Sharma S et al (2006) Haemophagocytic syndrome associated with visceral leishmaniasis. Indian J Paediatr 73:71–72Google Scholar
  9. 9.
    Gupta AP, Parate SN, Bobhate SK et al (2009) Haemophagocytic syndrome: a cause for fatal outcome in tuberculosis. Indian J Path Microbiol 52(2):260–262CrossRefGoogle Scholar
  10. 10.
    Nandi M, Ganguly SK, Mondal R et al (2010) Infection associated haemophagocytic syndrome in childhood tuberculosis: a case report. J Paediatr Infect Dis 5:91–94Google Scholar
  11. 11.
    Balasubramanium S, Karthigeyan K, Aparna V et al (2008) Tuberculosis associated haemophagocytic syndrome in infancy. Indian Paediatr 45:593–595Google Scholar
  12. 12.
    Palazzi L, McClain K, Caplan S (2003) Haemophagocytic syndrome in children: an important diagnostic consideration in fever of unknown origin. Clin Infect Dis 36(3):306–312PubMedCrossRefGoogle Scholar
  13. 13.
    Currimbhoy ZE (1995) Infection associated haemophagocytic syndrome. Indian Paediatr 32:285–290Google Scholar
  14. 14.
    Risdall JR, Robert W, McKenna RW et al (1979) Virus associated haemophagocytic syndrome. Cancer 44:993–1002PubMedCrossRefGoogle Scholar

Copyright information

© Indian Society of Haematology & Transfusion Medicine 2011

Authors and Affiliations

  1. 1.Clinical HaematologistCommand HospitalUdhampurIndia
  2. 2.PathologistCoomand HospitalUdhampurIndia

Personalised recommendations