A case of tuberculosis-induced hemophagocytic lymphohistiocytosis in a patient under hemodialysis.

The insidious onset, but rapid progression of hemophagocytic lymphohistiocytosis is always a diagnostic challenge. Herein, we report the case involving a 58-year-old man with diabetes-related nephropathy on dialysis who presented with fever of unknown origin, pancytopenia, and splenomegaly. A bone marrow smear showed extensive hemophagocytosis and the pathology disclosed granulomatous inflammation with caseous necrosis, suggestive of tuberculosis. Sputum culture and polymerase chain reaction confirmed tuberculosis. The patient exhibited signs of multiple-organ failure that were not reversed with anti-tuberculous medications and corticosteroids. The case reminds us that this is an uncommon clinical scenario, and only a timely diagnosis with prompt treatment results in a favorable outcome.