{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T13:11:40Z","timestamp":1788613900614,"version":"build-2803163510"},"reference-count":7,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,22]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>We report a case of a middle-aged man with no known comorbidities who presented with a 1-month history of fever, dry cough, weight loss and progressively worsening breathlessness.<\/jats:p>\n                  <jats:p>Initial investigations revealed declining haemoglobin, white blood cell and platelet levels, while a chest CT showed diffuse ground-glass opacities and a small pneumothorax. The patient was diagnosed with Evans syndrome (the co-occurrence of warm autoimmune haemolytic anaemia and bicytopenia) after a positive direct Coombs test and other haematological markers. Despite starting steroids, his fever persisted, leading to a further diagnosis of secondary haemophagocytic lymphohistiocytosis (HLH) after fulfilling six of eight HLH-2004 diagnostic criteria. Ultimately, disseminated tuberculosis was identified as the underlying trigger via endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal lymph nodes. The patient successfully recovered following a combined treatment of anti-tubercular therapy and steroids.<\/jats:p>","DOI":"10.1136\/bcr-2026-272271","type":"journal-article","created":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T12:15:20Z","timestamp":1788610520000},"page":"e272271","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Tuberculosis presenting as dual immune dysregulation: Evans syndrome and haemophagocytic lymphohistiocytosis"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9907-0542","authenticated-orcid":false,"given":"Jisha G","family":"Panicker","sequence":"first","affiliation":[{"name":"Pulmonary Medicine, AIIMS Patna, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Somesh","family":"Thakur","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, AIIMS Patna, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deependra Kumar","family":"Rai","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, AIIMS Patna, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6001-2446","authenticated-orcid":false,"given":"Javeeria","family":"Shabbir","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, AIIMS Patna, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishnan E","family":"Namboothri","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, AIIMS Patna, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5741-662X","authenticated-orcid":false,"given":"Sheetal","family":"Verma","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, AIIMS Patna, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thaodam Collin","family":"Singh","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, AIIMS Patna, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,5]]},"reference":[{"key":"2026090505150894000_19.9.e272271.1","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2021.676132","article-title":"Disseminated Tuberculosis Associated Hemophagocytic Lymphohistiocytosis in a Pregnant Woman With Evans syndrome: A Case Report and Literature Review","volume":"12","author":"Shi","year":"2021","journal-title":"Front Immunol"},{"key":"2026090505150894000_19.9.e272271.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-024-10220-7","article-title":"Comprehensive insights into tuberculosis-associated hemophagocytic lymphohistiocytosis: a systematic review","volume":"24","author":"Eslami","year":"2024","journal-title":"BMC Infect Dis"},{"key":"2026090505150894000_19.9.e272271.3","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofad697","article-title":"Tuberculosis-Associated Hemophagocytic Lymphohistiocytosis: Diagnostic Challenges and Determinants of Outcome","volume":"11","author":"Kurver","year":"2024","journal-title":"Open Forum Infect Dis"},{"key":"2026090505150894000_19.9.e272271.4","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21039"},{"key":"2026090505150894000_19.9.e272271.5","doi-asserted-by":"publisher","DOI":"10.1002\/hon.960"},{"key":"2026090505150894000_19.9.e272271.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2015.11.004"},{"key":"2026090505150894000_19.9.e272271.7","unstructured":"World Health Organization . WHO operational handbook on tuberculosis: module 4: treatment: drug-susceptible tuberculosis treatment. Geneva World Health Organization; 2022. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240050761"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-272271","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T12:15:21Z","timestamp":1788610521000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-272271"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":7,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,5]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bcr-2026-272271"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-272271","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}