TITLE:
Macrophage Activation Syndrome Revealing Tuberculous Lymphadenitis in an Adolescent: A Case Report and Review of Literature
AUTHORS:
Sofia Hamdani, Houda Nassih, Douaa Kaouani, Mariam Lagrine, Rabiy El Qadiry, Aicha Bourrahouat, Imane Ait Sab
KEYWORDS:
Macrophage Activation Syndrome, Hemophagocytic Lymphohistiocytosis, Tuberculosis, Tuberculous Lymphadenitis, Child, Hyperferritinemia
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.16 No.3,
May
21,
2026
ABSTRACT: Background: Macrophage activation syndrome (MAS), considered within the spectrum of secondary hemophagocytic lymphohistiocytosis (HLH), is a fulminant hyperinflammatory syndrome caused by uncontrolled activation of macrophages, T lymphocytes, and cytokine pathways. Infection-triggered MAS is well recognized, but tuberculosis remains an uncommon and underdiagnosed precipitant in children, particularly when the underlying focus is extrapulmonary. Case presentation: We report on the case of a 14-year-old adolescent admitted for prolonged fever, marked weight loss, cervical lymphadenopathy, and splenomegaly. The biological work-up disclosed bicytopenia, hyperferritinemia, and hypertriglyceridemia, raising suspicion of MAS/secondary HLH. Bone marrow aspiration demonstrated hemophagocytosis. Etiological investigations subsequently identified tuberculous lymphadenitis, confirmed by histopathology showing caseating granulomatous inflammation and molecular detection of Mycobacterium tuberculosis. Management and outcome: The patient received corticosteroid therapy to control the hyperinflammatory state together with antituberculous treatment, with favorable clinical and laboratory evolution. Conclusion: Tuberculosis-associated MAS should be considered in any child from a tuberculosis-endemic setting who presents with persistent fever, cytopenias, hyperferritinemia, organomegaly, and unexplained inflammatory syndrome. Early recognition of HLH features, rapid etiological investigation, and prompt initiation of both antituberculous therapy and appropriate immunomodulation are essential to improve outcome.