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Table 1 Summary of investigations

From: Epilepsia partialis continua complicated by disseminated tuberculosis and hemophagocytic lymphohistiocytosis: a case report

Investigation Results Differential diagnosis
Peripheral blood investigations Pancytopenia: Hemoglobin 86 g/L, mean cell volume 86 fL, white cell count 0.1 × 109/L (neutrophil count 0.00 × 109/L, lymphocyte count 0.17 × 109/L), platelets 18 × 109/L, low natural killer cell levels (at 6% detected in an HIV immunology screen)
Raised ferritin: 127,985 μg/L
Raised C-reactive protein: 123 mg/L
Abnormal liver function: Bilirubin 22 μmol/L, alkaline phosphatase 219 U/L, alanine aminotransferase 27 U/L, γ-glutamyl transferase 356 U/L
Raised lactate dehydrogenase: 2567 U/L
Normal renal function: Sodium 143 mmol/L, potassium 4.3 mmol/L, urea 4.0 mmol/L, creatinine 52 μmol/L
Normal clotting: Prothrombin time 14 seconds, activated partial thromboplastin time 29 seconds, fibrinogen 2.4 g/L
Negative HIV test
Positive antinuclear antibody and positive anti-Ro (> 100.0 U/mL), negative anti-LA/Sm/Scl70/Jo1
Hemophagocytic lymphohistiocytosis
Autoimmune disease (for example, systemic lupus erythematosus or Sjögren’s syndrome, which may cause macrophage activation syndrome)
Infection/sepsis
Aplastic anemia (for example, idiopathic)
Marrow infiltration (for example, acute leukemias)
Thrombotic thrombocytopenic purpura, hemolytic uremic syndrome
X-ray Chest x-ray (Fig. 1): Bilateral perihilar opacification Pneumocystis pneumonia
Atypical pneumonia
Hypersensitivity pneumonitis
Pulmonary tuberculosis
Computed tomography CT of the chest, abdomen, and pelvis with contrast: Abnormal lungs with widespread acinar ground glass opacification, intralobular thickening, and nodular change in a predominantly perihilar distribution. A moderate-sized right pleural effusion was noted. There were no enlarged axillary, supraclavicular, or mediastinal lymph nodes. There was no evidence of pulmonary embolism. Acalculous cholecystitis was noted. Pulmonary tuberculosis
Lymphoma
Sarcoidosis
Lumbar puncture LP opening pressure not recorded; routine CSF was unremarkable with protein of 0.62 g/L, no white cells, and glucose 3.0 mmol/L (paired serum glucose not recorded). Nondiagnostic routine CSF biochemistry and cell counts
Microbiology Routine cultures (blood, urine, sputum, CSF): No growth
Pneumocystis jirovecii PCR negative, Legionella antigen and PCR negative, respiratory mycology negative, routine respiratory culture negative
Mycobacterial cultures positive (blood, urine, sputum, CSF): Mycobacterium tuberculosis
Disseminated Mycobacterium tuberculosis
Note: Acellular CSF in CNS tuberculosis is possible and well-described [11]
  1. Abbreviations: g Grams, L liter, HIV Human immunodeficiency virus, μg Microgram, mg Milligram, μmol Micromole, U Units, mmol Millimoles, mL milliliter, CT Computed tomography, TB Tuberculosis, LP Lumbar puncture, CSF Cerebrospinal fluid, PCR Polymerase chain reaction, CNS Central nervous system