Case Report: Case report: Macrophage activation syndrome due to multifocal tuberculosis in an immunocompromised patient

TL;DR

A 26-year-old woman with Crohn's disease developed a rare and severe immune condition called MAS due to tuberculosis in multiple body areas.

Contribution

This case highlights the rare but critical link between multifocal tuberculosis and MAS in immunocompromised patients.

Findings

MAS was diagnosed in a patient with multifocal tuberculosis and immunosuppressive therapy for Crohn’s disease.

Tuberculosis was confirmed in bone marrow and fluid samples, with signs of immune overactivation and hemophagocytosis.

The case emphasizes the diagnostic challenges and the need for early anti-tuberculosis treatment to prevent complications.

Abstract

Macrophage Activation Syndrome (MAS) is a serious and life-threatening complication defined by excessive immune activation. While it’s commonly associated with rheumatic diseases, infections can also trigger MAS, with tuberculosis being a rare but significant cause. This case report discusses a rare occurrence of Macrophage Activation Syndrome (MAS) caused by multifocal tuberculosis in an immunocompromised patient with Crohn’s disease receiving immunosuppressive treatment. The patient is a 26-year-old woman with Crohn’s disease who is being treated with azathioprine. She arrived at the hospital battling persistent abdominal pain, overwhelming fatigue, and fever. Upon examination, splenomegaly and ascites were noted. A chest X-ray revealed bilateral pleural effusion consistent with tuberculosis. A CT scan confirmed the presence of pleural, pericardial, and intraperitoneal fluid. Blood tests indicated pancytopenia, hyperferritinemia, and hypofibrinogenemia. The analysis of ascitic fluid suggested an exudate. The PCR test of the bone marrow aspirate was positive for tuberculosis without rifampicin resistance, and the smear showed hemophagocytosis images. The patient was diagnosed with Macrophage Activation Syndrome secondary to multifocal tuberculosis. This report delves into the complex relationship between MAS and tuberculosis, emphasizing the challenges in diagnosing MAS in such cases and the potential link to tuberculosis. The complex diagnostic landscape of multifocal tuberculosis, which can often mimic malignancies, underscores the importance of promptly detecting and starting anti-tuberculosis interventions for improved clinical outcomes and the prevention of associated complications.

Figures