결핵성 심막염으로 항결핵약을 복용하던 중 발생한 혈구 탐식증후군 1예
A Case of Tuberculosis-associated Hemophagocytic Syndrome during Antituberculosis Medication for Tuberculous Pericarditis
강지영 (가톨릭대학교)
이보희 (가톨릭의대)
김윤지 (가톨릭의대)
이정은 (가톨릭대학교)
민진수 (가톨릭의대)
강민규 (가톨릭의대)
김경희 (가톨릭대학교)
윤형규 (가톨릭대학교)
송정섭 (가톨릭대학교)
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Abstract
A 63-year old woman was admitted to our hospital for an evaluation of thrombocytopenia. She had been diagnosed with tuberculous pericarditis three months earlier in a local clinic and treated with anti-tuberculosis medication. Two months later, thrombocytopenia developed. The medication was subsequently stopped because it was suspected that the anti-tuberculosis medication, particularly rifampin, might have caused the severe platelet reduction. However, the thrombocytopenia was more aggravated. A bone marrow biopsy was performed, which showed moderate amounts of histiocytes with active hemophagocytosis. This finding strongly suggested that the critical thrombocytopenia had been caused by hemophagocytic syndrome, not by the side effects of the anti-tuberculosis medication. Furthermore, the development of hemophagocytosis might have been due to an uncontrolled tuberculosis infection and its associated aberrant immunity. Therefore, she was started with both standard anti-tuberculosis medication and chemotherapy using etoposide plus steroid. One month after the initiation of treatment, the thrombocytopenia had gradually improved and she was discharged in a tolerable condition. At the third month of the follow-up, her platelet level and ferritin, the activity marker of hemophagocytic syndrome, was within the normal range
- keywords
- Hemophagocytic syndrome, Tuberculosis pericarditis, Antituberculosis medication
참고문헌
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