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Disseminated tuberculosis presenting as hemophagocytic lymphohistiocytosis in an immunocompetent adult patient: a case report

Overview of attention for article published in Journal of Medical Case Reports, December 2015
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1 tweeter
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1 Facebook page

Citations

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11 Dimensions

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38 Mendeley
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Title
Disseminated tuberculosis presenting as hemophagocytic lymphohistiocytosis in an immunocompetent adult patient: a case report
Published in
Journal of Medical Case Reports, December 2015
DOI 10.1186/s13256-015-0772-8
Pubmed ID
Authors

P V T M Rathnayake, W K S Kularathne, G C V De Silva, B M S B Athauda, S N N K Nanayakkara, A. Siribaddana, D. Baminiwatte

Abstract

Hemophagocytic lymphohistiocytosis is a frequently fatal and likely underdiagnosed disease. It is a rare occurrence in adults and usually secondary to an insult such as viral infections, bacterial infections, autoimmune connective tissue disorders, malignancies and immunocompromised states, in contrast to its childhood counterpart, which is due to a genetic defect but may share some of same genetic etiologies. It is characterized by multisystem inflammation due to unregulated proliferation and infiltration of macrophages and CD8 T cells in the bone marrow, which leads to phagocytosis of red blood cells, platelets, lymphocytes and their precursors. A 40-year-old Sri Lankan woman presented with a high-grade fever of 2 weeks' duration and the initial workup, including a thorough clinical examination, and all the investigations, including a septic screen, were normal. On the 18th day of hospital admission, she was found to have yellowish retinal lesions, which were confirmed as choroid tubercles by the consultant eye surgeon. Two days later she became pancytopenic and a bone marrow biopsy confirmed the diagnosis of hemophagocytic lymphohistiocytosis. She was treated with conventional category-1 antituberculous drugs and an initial 2 weeks with high-dose oral dexamethasone. All the choroid tubercles gradually disappeared and she recovered completely without any complications. In an adult patient with hemophagocytic lymphohistiocytosis, it is pivotal to understand the underlying etiology, as it needs extensive immunosuppression. If this patient had been treated with immunosuppressants without antituberculous medications, it would have been lethal with disseminated or central nervous system tuberculosis. So, in areas where tuberculosis is endemic, if no underlying cause is found, it may be worth considering antituberculous treatment for these patients. Re-evaluation with thorough clinical examination is of utmost importance in any patient with pyrexia of unknown origin as well as in any disease with unusual manifestations.

Twitter Demographics

The data shown below were collected from the profile of 1 tweeter who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 38 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Uruguay 1 3%
Unknown 37 97%

Demographic breakdown

Readers by professional status Count As %
Student > Master 9 24%
Researcher 5 13%
Other 4 11%
Student > Doctoral Student 3 8%
Professor 3 8%
Other 10 26%
Unknown 4 11%
Readers by discipline Count As %
Medicine and Dentistry 18 47%
Social Sciences 3 8%
Nursing and Health Professions 2 5%
Immunology and Microbiology 2 5%
Pharmacology, Toxicology and Pharmaceutical Science 1 3%
Other 3 8%
Unknown 9 24%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 16 August 2016.
All research outputs
#5,978,854
of 8,268,966 outputs
Outputs from Journal of Medical Case Reports
#757
of 1,518 outputs
Outputs of similar age
#200,162
of 317,569 outputs
Outputs of similar age from Journal of Medical Case Reports
#12
of 30 outputs
Altmetric has tracked 8,268,966 research outputs across all sources so far. This one is in the 24th percentile – i.e., 24% of other outputs scored the same or lower than it.
So far Altmetric has tracked 1,518 research outputs from this source. They receive a mean Attention Score of 3.3. This one is in the 42nd percentile – i.e., 42% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 317,569 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 31st percentile – i.e., 31% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 30 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 56% of its contemporaries.