類風溼性關節炎病患接受生物製劑治療發生結核性肋膜炎－－個案報告

Tuberculous pleurisy diagnosed by thoracoscopy in a biologics-treated rheumatoid arthritis patient

Hemophagocytic syndrome (HS) is a clinicopathologic entity characterized by a high-grade fever, hepatosplenomegaly, cytopenias, a high ferritin level, and increased macrophage proliferation and activation with hemophagocytosis. Though the diagnosis is complicated, HS can be the initial manifestation of systemic lupus erythematosus (SLE), because of some common features they share. A previously healthy 36-year-old female presented with two days of fever, chills, nausea, and vomiting. On admission, vitals were as follows: BP: 109/77 mmHg, PR: 94/min, RR:18/min and BT: 38.8°C.The patient’s laboratory values on presentation were significant for creatinine 2.9 mg/dL, hemoglobin 8.6 g/dL, absolute neutrophil count 1209/μL, and platelet count 3.4x104/μL. Later lab results showed fibrinogen 153.5 mg/dL, SGOT 717 U/L, SGPT 374U/L, alkaline phosphatase 109 U/L, LDH 446 U/L, triglyceride 159 mg/dL, and ferritin 2597.1 ng/mL. A 24-h urine protein test presented an amount of 0.34 g. Blood culture and serology for hepatitis B and C were both negative, and there was no evidence of parasite infestation. Mild splenomegaly of 14.2 cm was discovered by ultrasound. Bone marrow examination was done due to fever and cytopenia, which revealed a histiocyte engulfing several lympohcytes (arrow), indicating the presence of hemaphagocytosis (immunohisochemical study, CD68).