Tuberculosis presenting as dual immune dysregulation: Evans syndrome and haemophagocytic lymphohistiocytosis.
Jisha G Panicker, Somesh Thakur, Deependra Kumar Rai et al.
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Case in brief
A middle-aged man with no prior health issues presented with a month-long history of fever, dry cough, weight loss, and worsening breathlessness. Initial tests showed declining blood counts and a chest CT revealed ground-glass opacities and a small pneumothorax. He was diagnosed with Evans syndrome and later secondary haemophagocytic lymphohistiocytosis. Ultimately, disseminated tuberculosis was identified as the underlying cause, and the patient recovered with anti-tubercular therapy and steroids.
Diagnostic / clinical pearl
Clinicians should consider disseminated tuberculosis in patients presenting with immune dysregulation syndromes, such as Evans syndrome and HLH, especially when initial treatments fail.