Secondary hemophagocytic lymphohistiocytosis and isolated cerebellar ataxia due to disseminated tuberculosis with challenging management: A rare case report

Abstract: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disorder which occurs due to excessive immune response and high cytokine levels leading to tissue damage and organ failure. HLH can be primary and secondary. The etiology and presentation of secondary HLH remain diverse. Treatment of secondary HLH includes management of primary conditions and immunosuppressives. Several cases of secondary HLH due to tuberculosis (TB) have been reported in the past although their management beyond antitubercular therapy and follow-up was not reported. Here, we present a rare case report of secondary HLH and isolated cerebellar ataxia due to disseminated TB that responded to intravenous immunoglobulin in addition to antitubercular therapy and steroids. Patients showed complete response to therapy with normalization of hematological parameters and bone marrow findings. The patient was declared cured after 6 months of treatment.