Abstract
This article presents a case of an acute onset in a middle-aged male who exhibited persistent high fever (temperature > 40 °C), delirium, and respiratory distress. Initial chest CT only suggested "bilateral pneumonia," and empirical anti-infection treatment proved ineffective. The patient subsequently developed pancytopenia, splenomegaly, and markedly elevated ferritin levels (848.90 μg/L). Bone marrow aspiration demonstrated hemophagocytic activity and granulomatous lesions. A positive TB-PCR, confirmed the diagnosis of early hematogenous disseminated tuberculosis complicated by the hemophagocytic syndrome (HLH). The patient's condition gradually improved Following, individualized anti-tuberculosis therapy and immunosuppressive treatment. The uniqueness of this case lies in two main aspects: (1) early imaging did not show typical miliary nodules, which could have led to misdiagnosis as common pneumonia; (2) the dissemination of tuberculosis and onset of HLH occurred almost simultaneously, creating a therapeutic dilemma. Although tuberculosis complicated by HLH is rare, it poses significant danger. The cornerstone of treatment is effective control of the tuberculosis infection while simultaneously suppressing the excessive immune response. This case highlights the importance of considering tuberculosis complicated by HLH in patients with recurrent fever and pulmonary infiltrates. Early diagnosis and prompt treatment are crucial for improving prognosis. The article also discusses the underlying pathogenesis, offering valuable insights for clinical practice.