{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T02:58:44Z","timestamp":1780801124757,"version":"3.54.1"},"update-to":[{"DOI":"10.12688\/f1000research.158982.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T00:00:00Z","timestamp":1744848000000}}],"reference-count":17,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T00:00:00Z","timestamp":1744848000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>Macrophage Activation Syndrome (MAS) is a serious and life-threatening complication defined by excessive immune activation. While it\u2019s commonly associated with rheumatic diseases, infections can also trigger MAS, with tuberculosis being a rare but significant cause. This case report discusses a rare occurrence of Macrophage Activation Syndrome (MAS) caused by multifocal tuberculosis in an immunocompromised patient with Crohn\u2019s disease receiving immunosuppressive treatment. The patient is a 26-year-old woman with Crohn\u2019s disease who is being treated with azathioprine. She arrived at the hospital battling persistent abdominal pain, overwhelming fatigue, and fever. Upon examination, splenomegaly and ascites were noted. A chest X-ray revealed bilateral pleural effusion consistent with tuberculosis. A CT scan confirmed the presence of pleural, pericardial, and intraperitoneal fluid. Blood tests indicated pancytopenia, hyperferritinemia, and hypofibrinogenemia. The analysis of ascitic fluid suggested an exudate. The PCR test of the bone marrow aspirate was positive for tuberculosis without rifampicin resistance, and the smear showed hemophagocytosis images. The patient was diagnosed with Macrophage Activation Syndrome secondary to multifocal tuberculosis. This report delves into the complex relationship between MAS and tuberculosis, emphasizing the challenges in diagnosing MAS in such cases and the potential link to tuberculosis. The complex diagnostic landscape of multifocal tuberculosis, which can often mimic malignancies, underscores the importance of promptly detecting and starting anti-tuberculosis interventions for improved clinical outcomes and the prevention of associated complications.<\/ns3:p>","DOI":"10.12688\/f1000research.158982.2","type":"journal-article","created":{"date-parts":[[2025,4,18]],"date-time":"2025-04-18T05:10:09Z","timestamp":1744953009000},"page":"1439","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Macrophage activation syndrome due to multifocal tuberculosis in an immunocompromised patient"],"prefix":"10.12688","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6398-1610","authenticated-orcid":false,"given":"Salma","family":"Riahi","sequence":"first","affiliation":[{"name":"Laboratory of Hematology Sousse Sousse Sahloul Hospital"},{"name":"Sousse Sousse University of Sousse Faculty of Medicine of Sousse"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sana","family":"Ammar","sequence":"additional","affiliation":[{"name":"Laboratory of Hematology Sousse Sousse Sahloul Hospital"},{"name":"Monastir Monastir University of Monastir Faculty of Pharmacy of Monastir"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houssem","family":"Hassen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Sousse Sousse Sahloul Hospital"},{"name":"Monastir Monastir University of Monastir Faculty of Medicine of Monastir"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emna","family":"Souilem","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Sousse Sousse Sahloul Hospital"},{"name":"Sousse Sousse University of Sousse Faculty of Medicine of Sousse"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donia","family":"Mbarki","sequence":"additional","affiliation":[{"name":"Laboratory of Hematology Sousse Sousse Sahloul Hospital"},{"name":"Monastir Monastir University of Monastir Faculty of Pharmacy of Monastir"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5245-2876","authenticated-orcid":false,"given":"Yosra","family":"Dhaha","sequence":"additional","affiliation":[{"name":"Laboratory of Hematology Sousse Sousse Sahloul Hospital"},{"name":"Sousse Sousse University of Sousse Faculty of Medicine of Sousse"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehdi","family":"Ksiaa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Sousse Sousse Sahloul Hospital"},{"name":"Sousse Sousse University of Sousse Faculty of Medicine of Sousse"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amina","family":"Bouatay","sequence":"additional","affiliation":[{"name":"Laboratory of Hematology Sousse Sousse Sahloul Hospital"},{"name":"Monastir Monastir University of Monastir Faculty of Pharmacy of Monastir"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2025,4,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"927-941","DOI":"10.1016\/j.hoc.2015.06.010","article-title":"Macrophage Activation Syndrome.","volume":"29","author":"A Ravelli","year":"2015","journal-title":"Hematol. 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