25 February 2026
: Case report 
A 70-Year-Old Woman Receiving Immunosuppressive Therapy Presenting With Iliopsoas Abscess, Pulmonary Miliary Tuberculosis, and Secondary Hemophagocytic Lymphohistiocytosis
Challenging differential diagnosis, Rare coexistence of disease or pathology
Shun Nakahara BE 1, Shunsuke Kondo
ABEF 1*, Christian John Capirig DEF 1, Kazushige Shiraishi E 1, Miho Nakamura E 2, Osamu Hamada EF 3,4
DOI: 10.12659/AJCR.950376
Am J Case Rep 2026; 27:e950376
Table 1 Laboratory data of the patient on admission (hematology, biochemistry, serology and immunology, coagulation).
| (Reference range) | (Reference range) | ||||||
|---|---|---|---|---|---|---|---|
| WBC | 2700 | 4000–9000 | /μL | CRP | 10.1 | <0.3 | mg/dL |
| Neu | 60.8 | 45–70 | % | ANA | <40 | <40 | |
| Eos | 0 | 2–10 | % | C3 | 90 | 65–135 | mg/dL |
| Mono | 8.6 | 3–10 | % | C4 | 20 | 13–35 | mg/dL |
| Lym | 30.6 | 30–45 | % | CH50 | 40 | 30–45 | |
| RBC | 3.2 | 4.2–5.5 | ×10/μL | RF | − | − | |
| Hb | 9.3 | 13.5–18.0 | g/dL | P-ANCA | − | − | |
| Hct | 28.7 | 36.0–54.0 | % | C-ANCA | − | − | |
| Plt | 12.3 | 15–35 | ×10/μL | Jo-1 Antibody | − | − | |
| Anti-SSA Antibody | − | − | |||||
| Anti-SSB Antibody | − | − | |||||
| T-Bil | 1.0 | 0.3–1.2 | mg/dL | IgG | 1165 | 870–1700 | mg/dL |
| AST | 141 | 13–33 | U/L | IgA | 422 | 110–410 | mg/dL |
| ALT | 86 | 8–42 | U/L | IgM | 119 | 33–190 | mg/dL |
| ALP | 149 | 115–359 | U/L | Ferritin | 626.2 | 8–429 | ng/mL |
| LDH | 485 | 119–229 | U/L | sIL-2R | 6160 | 120–600 | U/mL |
| BUN | 15.3 | 8–22 | mg/dL | T-SPOT. TB | + | − | |
| Cre | 1.0 | 0.6–1.1 | mg/dL | ||||
| Na | 140 | 138–146 | mEq/L | ||||
| K | 3.5 | 3.6–4.9 | mEq/L | PT-INR | 1.25 | 0.9–1.14 | |
| Cl | 106 | 99–109 | mEq/L | APTT | 47.8 | 24–40 | s |
| BS | 86 | 80–112 | mg/dL | Fibrinogen | 374 | 150–340 | mg/dL |
| Lactate | 9 | 9–14 | mg/dL | ||||
| NT-proBNP | 690 | <125 | pg/mL | ||||
| TG | 356 | 30–149 | mg/dL | ||||
| WBC – white blood cell; Neu – neutrophil; Eos – eosinophil; Mono – monocyte; Lym – lymphocyte; RBC – red blood cell; Hb – hemoglobin; Hct – hematocrit; Plt – platelet; T-Bil – total bilirubin; AST – aspartate aminotransferase; ALT – alanine aminotransferase; ALP – alkaline phosphatase; LDH – lactate dehydrogenase; BUN – blood urea nitrogen; Cre – creatinine; BS – blood sugar; NT-proBNP – N-terminal pro B-type natriuretic peptide; TG – triglyceride; CRP – C-reactive protein; ANA – antinuclear antibody; C3 – complement 3; C4 – complement 4; CH50 – 50% hemolytic complement activity, RF – rheumatoid factor; P-ANCA – perinuclear anti-neutrophil cytoplasmic antibody; C-ANCA – cytoplasmic anti-neutrophil cytoplasmic antibody; Anti-SSA Antibody – anti-Sjögren’s syndrome A antibody; Anti-SSB Antibody – anti-Sjögren’s syndrome B antibody; IgG – immunoglobulin G; IgA – immunoglobulin Al IgM – immunoglobulin M; sIL-2R – soluble interleukin-2 receptor; T-SPOT.TB – T-cell spot test for tuberculosis; PT-INR – international normalized ratio; APTT – activated partial thromboplastin time, ‘+’ – positive; ‘−’ – negative. | |||||||