Difficultés diagnostiques d'un exanthème fébrile d'étiologies différentes chez une même patiente tuberculeuse à Madagascar Difficulties in the diagnosis of a febrile exanthema of different etiologies in a tuberculous patient in Madagascar

This article illustrates the difficulties in the treat- ment of tuberculosis through the case of a patient with tuber- culosis presenting with a haemophagocytic syndrome, severe drug hypersensitivity and a dissemination of the disease. A month after tuberculosis chemotherapy was star- ted, Mrs. R.S, aged 45 years, presented with febrile exan- thema, confusion, multiple lymph nodes enlargement/polya- denopathy, bi-cytopenia and a severe hepatic cytolysis. The haemophagocytic syndrome was confirmed by a myelogram and had shown a good response to the administration of methylprednisolone. Tuberculosis chemotherapy was stop- ped for a month and when resumed, there was a recurrence of the febrile exanthema without haematologic abnormalities but a moderate hepatic cytolysis. The association of haemo- phagocytic syndrome with tuberculosis is a rare occurrence. It was important to differentiate drug hypersensitivity and recurrence of haemophagocytic syndrome, as the sole treat- ment interruption was sufficient to heal the patient during the second febrile rash. Corticotherapy, discontinuation of tuber- culostatic treatment and a very progressive reintroduction of antituberculosis drugs was successful though it caused the dissemination of the tuberculosis disease.