CASE REPORT article
Front. Immunol.
Sec. Microbial Immunology
This article is part of the Research TopicCommunity Series in Deciphering Host-Pathogen Interactions in Tuberculosis: Implications for Diagnostics and Therapeutics Volume IIView all articles
Tuberculosis-Triggered Cytokine Storm with Hemophagocytic Lymphohistiocytosis and Tuberculous Spondylitis in an Apparently Immunocompetent Host: A Case Report and Literature Review
Provisionally accepted
- 1The First Affiliated Hospital of Yangtze University, Jingzhou, China
- 2The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Hemophagocytic lymphohistiocytosis (HLH) secondary to disseminated tuberculosis (TB) is a rare, life-threatening hyperinflammatory syndrome. We present a 60-year-old man with recurrent fever and syncope. Workup revealed cytopenias, hyperferritinemia (peak 5,802 ng/mL), elevated C-reactive protein (CRP), and hepatic dysfunction, fulfilling HLH-2004 criteria. Imaging showed miliary lung nodules and tuberculous spondylitis at T9. Bone marrow biopsy confirmed hemophagocytosis, and next-generation sequencing identified Mycobacterium tuberculosis. This case demonstrates that disseminated TB can trigger a fulminant cytokine storm even in an elderly host without overt immunodeficiency. Successful outcomes require combined antitubercular and immunomodulatory therapy.
Keywords: hemophagocytic lymphohistiocytosis, Tuberculous spondylitis, disseminatedpulmonarytuberculosis, Casereport, hyperinflammation, CytokineStorm, immunosenescence
Received: 30 Aug 2025; Accepted: 10 Nov 2025.
Copyright: © 2025 Zhu, Lu and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jinzhi Lu, jinzhilu2015@163.com
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