신이식 환자에서 발생한 결핵에 의한 혈구탐식 증후군 (Hemophagocytic Syndrome)

Hemophagocytic syndrome is a rare syndrome characterized by fever, weight loss, profound pancytopenia, lymphadenopathy, hepatosplenomegaly and the pathologic finding of hemophagocytosis (phagocytosis by macrophages of erythrocytes, leukocytes, platelets, and their precursors) in bone marrow and other tissue. This syndrome can be associated with viral infections and lymphoid neoplasia, bacteria, fungus and drugs. Hyperproduction of cytokines, including interferon-γ, tumor necrosis factor-α, may play a role in the pathogenesis of hemophagocytosis. Authors experienced a rare case of bemophagocytic syndrome associated with tuberculosis in a 40-year-old female who had undergone renal transplantation 12 years ago and received triple immunotherapy. After the beginning of antituberculosis therapy, the laboratory disturbances disappeared and clinical symptoms improved. Tuberculosis is a common infection in Korea. Therefore, we would like to recommend early bone marrow biopsy and antituberculosis therapy if fever of unknown origin, hepatosplenomegaly and pancytopenia in immunosupressive patients.