An indeterminate result of QuantiFERON-TB Gold In-Tube for miliary tuberculosis due to a high level of IFN-[gamma] production

• Published in: International journal of hematology 2014-04, Vol.99 (4), p.523
• Main Authors: Hangai, Sho, Yoshimi, Akihide, Hosoi, Atsuko, Matsusaka, Keisuke, Ichikawa, Motoshi, Fukayama, Masashi, Kurokawa, Mineo
• Format: Article
• Language: English
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1007/s12185-014-1504-3

Issue Title: Including PIH Articles on Recent Progress in Gene Therapy The QuantiFERON-TB Gold In-Tube^sup ^ test has excellent specificity for Mycobacterium tuberculosis. However, diagnosis of miliary tuberculosis remains challenging, and the interpretation of QuantiFERON^sup ^ results in immunocompromised individuals has not been fully established. Here, we present a patient with military tuberculosis who showed an indeterminate QuantiFERON^sup ^ result. A 76-year-old male presented with fever and pancytopenia. Radiological tests did not show the classical miliary pattern. Acid-fast staining and polymerase chain reaction of several specimens were negative for M. tuberculosis. The QuantiFERON^sup ^ responses were indeterminate on two separate tests, as interferon-γ (IFN-γ) concentration was high in the negative control. The patient did not respond to anti-microbiological therapy, and developed sepsis and disseminated intravascular coagulation, leading to lethal intracranial hemorrhage. An autopsy showed miliary tuberculosis and aplastic anemia. A literature review suggests a tendency towards indeterminate or false-negative QuantiFERON^sup ^ results in immunocompromised individuals or patients with miliary tuberculosis due to low production of IFN-γ. Our patient, however, showed substantial amounts of IFN-γ despite lymphocytopenia, which has not been reported in the literature. The present case suggests that indeterminate results of QuantiFERON^sup ^ should be interpreted with caution, as IFN-γ production in patients with miliary tuberculosis can vary significantly, even with sustained lymphocytopenia.[PUBLICATION ABSTRACT]