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Case Report
Fatal diagnosis of hemophagocytic lymphohistiocytosis in a patient with a history of human immunodeficiency virus, Hodgkin’s lymphoma, and Epstein–Barr virus
1 Department of Internal Medicine, The Christ Hospital, 2139 Auburn Ave, Cincinnati, Ohio 45219, USA
2 Pulmonary and Critical Care, The Christ Hospital, 2139 Auburn Ave, Cincinnati, Ohio 45219, USA
Address correspondence to:
Chelsea Taylor Schwartz
DO, Department of Internal Medicine, The Christ Hospital, 2139 Auburn Ave, Cincinnati, Ohio 45219,
USA
Message to Corresponding Author
Article ID: 100063Z10CS2019
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How to cite this article
Schwartz CT, Schmitt CB. Fatal diagnosis of hemophagocytic lymphohistiocytosis in a patient with a history of human immunodeficiency virus, Hodgkin’s lymphoma, and Epstein–Barr virus. J Case Rep Images Oncology 2019;5:100063Z10CS2019.ABSTRACT
Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare hyperinflammatory syndrome with high rates of mortality. Secondary HLH is acquired from an underlying illness and therefore difficult to diagnosis because the underlying disease can mask the symptoms of HLH or have a similar presentation. Therefore, it is important for physicians and health care providers to be familiar with HLH to keep in mind as a differential diagnosis in critically ill patients. It is imperative to start treatment early to decrease mortality.
Case Report: We describe a case of a 42-year-old African-American man with a past medical history of human immunodeficiency virus (HIV), Hodgkin’s lymphoma, and Epstein–Barr virus (EBV) who presented to the emergency department (ED) with diarrhea, nausea, and vomiting. He was ultimately diagnosed with acquired HLH. Early on during his admission he was treated with dexamethasone, but continued into multiple organ failure and succumbed on the 11th hospital day.
Conclusion: Hemophagocytic lymphohistiocytosis is a rare disease and may not initially or come to mind at all as part of a differential diagnosis in critically ill patients. It is important for physicians to be aware of how the disease presents and the underlying diseases that can cause HLH as reported in this case report. Early diagnosis is crucial for early treatment before patient’s experience irreversible organ failure and death. This case report discusses the etiology, symptoms, diagnosis, and treatment of HLH to educate health care providers and decrease the mortality in this patient population.
Keywords: Epstein–Barr virus, Hemophagoyctic lymphohistiocytosis, Hodgkin’s lymphoma, Human immunodeficiency virus
SUPPORTING INFORMATION
Author Contributions
Christopher B Schmitt - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Chelsea Taylor Schwartz - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementThis is not accurate because the patient is deceased so consent was not obtained by the patient.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Chelsea Taylor Schwartz et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
