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Tuberculosis-associated hemophagocytic lymphohistiocytosis with subsequent unmasking cryptococcal immune reconstitution inflammatory syndrome (IRIS) in an HIV-negative man

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Abstract

A 22-year-old HIV-negative man from Ghana was diagnosed with severe hemophagocytic lymphohistiocytosis (HLH) induced by multiorgan tuberculosis with peritoneal, hepatic, pericardial, myocardial, pleural, pulmonary, and bone manifestation. His body mass index was 12.9 m2/kg. Bioptic material of a peritoneal biopsy grew M. tuberculosis, sensitive to all first-line antituberculous drugs. HLH resolved with antituberculous therapy, without additional anti-inflammatory therapy being given. The initial CT scan of his brain was normal. After 5 months of antituberculous treatment, he developed a paralysis of the left arm. A cerebral MRT showed ring-enhanced lesions. Blood cultures and lumbar puncture revealed Cryptococcus neoformans var. grubi. The HIV test was repeatedly negative. Antituberculous treatment was continued for a total of 9 months, and additional treatment with antifungal therapy was established. He recovered fully after 14 months of antifungal treatment.

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Authors and Affiliations

  1. Department of Tropical Medicine and Infectious Diseases, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany

    Hilte F. Geerdes-Fenge, Micha Löbermann, Christoph J. Hemmer & Emil C. Reisinger

  2. Institute for Microbiology, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany

    Orsolya Benedek

Authors
  1. Hilte F. Geerdes-Fenge
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  2. Micha Löbermann
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  3. Christoph J. Hemmer
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  4. Orsolya Benedek
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  5. Emil C. Reisinger
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Correspondence to Hilte F. Geerdes-Fenge.

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The authors have no conflicts of interest to declare. The patient gave written consent for publication.

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Geerdes-Fenge, H.F., Löbermann, M., Hemmer, C.J. et al. Tuberculosis-associated hemophagocytic lymphohistiocytosis with subsequent unmasking cryptococcal immune reconstitution inflammatory syndrome (IRIS) in an HIV-negative man. Infection 47, 129–133 (2019). https://doi.org/10.1007/s15010-018-1226-1

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  • DOI: https://doi.org/10.1007/s15010-018-1226-1

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