Hemophagocytic syndrome in patients infected with the human immunodeficiency virus: A study of 15 consecutive patients

Successful management of haemophagocytic lymphohistiocytosis in an adolescent with newly diagnosed HIV/AIDS and histoplasmosis

Haemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening hyperinflammatory syndrome characterised by persistent fevers, cytopenia, hepatosplenomegaly and systemic inflammation. Secondary HLH can be triggered by various aetiologies including infections, malignancies and autoimmune conditions. We highlight the complexity of HLH diagnosis and management by describing a case of an adolescent Salvadoran immigrant with HLH, newly diagnosed HIV, Streptococcal bacteraemia and disseminated histoplasmosis. The patient presented with neurological and ocular findings along with persistent fevers and cytopenia. He was diagnosed with HLH and treated with anakinra in addition to receiving treatment for HIV, Streptococcal bacteraemia and histoplasmosis. The patient's HLH resolved without corticosteroids or chemotherapy, which are considered the mainstays for HLH treatment. This case underscores the need for the evaluation and management of multiple infections and individualised management in patients presenting with HLH to achieve favourable outcomes.

Hemophagocytic Lymphohistiocytosis and Infection: A Literature Review

Hemophagocytic lymphocytosis (HLH) is a life-threatening, underdiagnosed syndrome caused by the excessive release of inflammatory mediators. Primary lymphocytosis is usually seen in young children and is associated with genetic defects, while secondary lymphocytosis is presented in adults due to malignancy, rheumatic disease, or infection. The aim of this study is to describe the infectious agents that trigger HLH in the adult population and provide diagnostic and treatment guidelines for this life-threatening syndrome. We conducted a literature review using PubMed as our basic database. We collected papers from the past six years that studied infectious agents that triggered HLH and described the most recommended treatment options for this serious condition. A total of 32 studies were included for this literature review.HLH is considered a syndrome with variable symptoms, and clinicians should be familiar with its complexity and the pathologies that could contribute to its presentation. Collaboration between physicians and awareness are basic steps for the management of patients with HLH.

An Unusual Case of Hemophagocytic Lymphohistiocytosis Presentation in Acute Human Immunodeficiency Virus

Hemophagocytic lymphohistiocytosis (HLH) in acute human immunodeficiency virus (HIV) patients has been scarcely reported in the English literature. To the best of our knowledge, only 12 cases have been described. We present a case of a 27-year-old male with no past medical history who was admitted with a new-onset headache, fever, night sweats, and chills. Further laboratory tests revealed transaminitis, leukopenia, thrombocytopenia, positive HIV antigen/antibody test, and markedly elevated ferritin levels, which promoted our suspicion of HLH. This case demonstrates HLH as an unusual presentation of HIV during its seroconversion stage. This report adds a rare disease process to the available literature, and we emphasize that markedly elevated ferritin levels in acute HIV patients should raise suspicion toward a diagnosis of HLH.