N Lerolle1, M Laanani2, L Galicier3, S Rivière4, J-L Meynard5, E Azoulay6, A Jeblaoui7, V Lalande8, F Mougari9, L Fardet10, P Coppo11, C Goujard12, J-M Molina13, O Lambotte14. 1. Service de médecine interne et d'immunologie clinique, Hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre. 2. Unité de Biostatistiques et Epidémiologie, Hôtel Dieu, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, Centre de recherche en Epidémiologie et Santé des Populations, Institut national de la santé et de la recherche médicale (INSERM) Unité 1018, Le Kremlin-Bicêtre. 3. Service d'Immunopathologie Clinique, Hôpital Saint Louis, APHP, Université Paris Diderot, Paris. 4. Service de Médecine interne, Hôpital Saint Antoine, APHP, Université Paris 6, Paris. 5. Service de Maladies infectieuses, Hôpital Saint Antoine, APHP, Université Paris 6, Paris. 6. Service de réanimation médicale, Hôpital Saint Louis, APHP, Université Paris 6, Paris. 7. Service de Microbiologie, Hôpital Bicêtre, APHP, Université Paris Sud, Le Kremlin-Bicêtre. 8. Service de Microbiologie, Hôpital Saint Antoine, APHP, Université Paris 6, Paris. 9. Service de Microbiologie, Hôpital Lariboisière, APHP, Université Paris Diderot, Paris. 10. Service de Dermatologie, Hôpital Henri Mondor, APHP, Université Paris 12, Créteil. 11. Service d'hématologie, Hôpital Saint Antoine, APHP, Université Paris 6, Paris. 12. Service de médecine interne et d'immunologie clinique, Hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, Centre de recherche en Epidémiologie et Santé des Populations, Institut national de la santé et de la recherche médicale (INSERM) Unité 1018, Le Kremlin-Bicêtre, Université Paris Sud, Le Kremlin-Bicêtre. 13. Service de maladies Infectieuses, Hôpital Saint Louis, APHP, Université Paris Diderot, Paris. 14. Service de médecine interne et d'immunologie clinique, Hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, Université Paris Sud, Le Kremlin-Bicêtre, Immunology of Viral Infections and Autoimmune Diseases, INSERM Unité 1184, Kremlin-Bicêtre, Life Sciences Division, Infectious Disease Models and Innovative Therapies, Commissariat à l'énergie atomique et aux énergies alternatives, Institute of Emerging Diseases and Innovative Therapies, Fontenay-aux-Roses, France.
Abstract
SETTING: Tuberculosis (TB) is a potential trigger of haemophagocytic syndrome (HS) but little is known about the features of TB-associated HS. OBJECTIVE: To assess the risk factors associated with HS in patients with TB. DESIGN: We performed a multicentre case-control study assessing the medical records of adult patients diagnosed with proven TB with (TB/HS+) or without (TB/HS-) associated HS. RESULTS: Twenty-one patients with TB/HS+ (24% women, median age, 37 years [IQR 30-48]) were included in the study. Eleven patients (52%) were infected with human immunodeficiency virus and seven patients (33%) were immunocompromised due to other reasons. TB was disseminated in 17 patients (81%). Compared with 50 control TB patients (TB/HS-), patients with TB/HS+ were more likely to be immunocompromised (86% vs. 18%; P < 0.001) and to present with disseminated TB (80% vs. 12%; P < 0.001). The outcome was poorer in patients with TB/HS+, with a higher admission rate to intensive care (71% vs. 0%; P < 0.001) and a higher risk of death (38% vs. 7%; P = 0.005). CONCLUSION: TB/HS+ occurred more likely in immunocompromised patients and severely impaired the prognosis of TB. Further studies are needed to devise therapeutic strategies for patients with TB/HS+.
SETTING:Tuberculosis (TB) is a potential trigger of haemophagocytic syndrome (HS) but little is known about the features of TB-associated HS. OBJECTIVE: To assess the risk factors associated with HS in patients with TB. DESIGN: We performed a multicentre case-control study assessing the medical records of adult patients diagnosed with proven TB with (TB/HS+) or without (TB/HS-) associated HS. RESULTS: Twenty-one patients with TB/HS+ (24% women, median age, 37 years [IQR 30-48]) were included in the study. Eleven patients (52%) were infected with human immunodeficiency virus and seven patients (33%) were immunocompromised due to other reasons. TB was disseminated in 17 patients (81%). Compared with 50 control TBpatients (TB/HS-), patients with TB/HS+ were more likely to be immunocompromised (86% vs. 18%; P < 0.001) and to present with disseminated TB (80% vs. 12%; P < 0.001). The outcome was poorer in patients with TB/HS+, with a higher admission rate to intensive care (71% vs. 0%; P < 0.001) and a higher risk of death (38% vs. 7%; P = 0.005). CONCLUSION:TB/HS+ occurred more likely in immunocompromised patients and severely impaired the prognosis of TB. Further studies are needed to devise therapeutic strategies for patients with TB/HS+.