, Volume 47, Issue 1, pp 129–133 | Cite as

Tuberculosis-associated hemophagocytic lymphohistiocytosis with subsequent unmasking cryptococcal immune reconstitution inflammatory syndrome (IRIS) in an HIV-negative man

  • Hilte F. Geerdes-FengeEmail author
  • Micha Löbermann
  • Christoph J. Hemmer
  • Orsolya Benedek
  • Emil C. Reisinger
Case Report


A 22-year-old HIV-negative man from Ghana was diagnosed with severe hemophagocytic lymphohistiocytosis (HLH) induced by multiorgan tuberculosis with peritoneal, hepatic, pericardial, myocardial, pleural, pulmonary, and bone manifestation. His body mass index was 12.9 m2/kg. Bioptic material of a peritoneal biopsy grew M. tuberculosis, sensitive to all first-line antituberculous drugs. HLH resolved with antituberculous therapy, without additional anti-inflammatory therapy being given. The initial CT scan of his brain was normal. After 5 months of antituberculous treatment, he developed a paralysis of the left arm. A cerebral MRT showed ring-enhanced lesions. Blood cultures and lumbar puncture revealed Cryptococcus neoformans var. grubi. The HIV test was repeatedly negative. Antituberculous treatment was continued for a total of 9 months, and additional treatment with antifungal therapy was established. He recovered fully after 14 months of antifungal treatment.


Tuberculosis Hemophagocytic lymphohistiocytosis HLH Unmasking IRIS Cryptococcosis 


Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare. The patient gave written consent for publication.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Hilte F. Geerdes-Fenge
    • 1
    Email author
  • Micha Löbermann
    • 1
  • Christoph J. Hemmer
    • 1
  • Orsolya Benedek
    • 2
  • Emil C. Reisinger
    • 1
  1. 1.Department of Tropical Medicine and Infectious DiseasesRostock University Medical CenterRostockGermany
  2. 2.Institute for MicrobiologyRostock University Medical CenterRostockGermany

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