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VOLUME 6 , ISSUE 4 ( October-December, 2020 ) > List of Articles


Uncommon Presentation of a Common Infection

Biswajit G Dastidar, Shazia Gulshan, Anindya Sarkar, Arup K Halder

Keywords : Ferritin, Hemophagocytic lymphohistiocytosis, Salmonella, Sepsis

Citation Information : Dastidar BG, Gulshan S, Sarkar A, Halder AK. Uncommon Presentation of a Common Infection. J Med Sci 2020; 6 (4):68-69.

DOI: 10.5005/jp-journals-10045-00159

License: CC BY-NC 4.0

Published Online: 30-11-2021

Copyright Statement:  Copyright © 2020; The Author(s).


Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a clinical syndrome resulting from the immunological hyperactivation of macrophages. The condition can be triggered by an infection, malignancy, or autoimmune disease. Though the current literatures demonstrated a significant portion of sepsis patients are probably suffering from HLH. Case description: Here, we present a case who presented like features of gram-negative sepsis but prompt diagnosis of HLH and treatment saved the patient's life. Conclusion: Hemophagocytic lymphohistiocytosis should be anticipated and recognized in fulminating sepsis-like conditions and promptly treated with steroids.

  1. Janka GE, Lehmberg K. Hemophagocytic syndromes--an update. Blood Rev 2014;28(4):135–142. DOI: 10.1016/j.blre.2014.03.002.
  2. Park HS, Kim DY, Lee JH, et al. Clinical features of adult patients with secondary hemophagocytic lymphohistiocytosis from causes other than lymphoma: an analysis of treatment outcome and prognostic factors. Ann Hematol 2012;91(6):897–904. DOI: 10.1007/s00277-011-1380-3.
  3. Rosado FGN, Kim AS. Hemophagocytic lymphohistiocytosis: an update on diagnosis and pathogenesis. Am J Clin Pathol 2013;139(6):713–727. DOI: 10.1309/AJCP4ZDKJ4ICOUAT.
  4. Lachmann G, Spies C, Schenk T, et al. Hemophagocytic lymphohistiocytosis: potentially underdiagnosed in intensive care units. Shock 2018;50(2):149–155. DOI: 10.1097/SHK.0000000000001048.
  5. Kumar V, Sharma B, Nigam AS. Case series of hemophagocytic lymphohistiocytosis from a tertiary care centre: an underdiagnosed entity. Turk Patoloji Derg 2019;35(3):207–212. DOI: 10.5146/tjpath.2018.01456.
  6. Machowicz R, Janka G, Wiktor-Jedrzejczak W. Similar but not the same: differential diagnosis of HLH and sepsis. Crit Rev Oncol Hematol 2017;114:1–12. DOI: 10.1016/j.critrevonc.2017.03.023.
  7. George MR. Hemophagocytic lymphohistiocytosis: review of etiologies and management. J Blood Med 2014;5:69–86. DOI: 10.2147/JBM.S46255.
  8. Jordan MB, Allen CE, Greenberg J, et al. Challenges in the diagnosis of hemophagocytic lymphohistiocytosis: recommendations from the North American consortium for histiocytosis (NACHO). Pediatr Blood Cancer 2019;66(11):e27929. DOI: 10.1002/pbc.27929.
  9. Allen CE, Yu X, Kozinetz CA, et al. Highly elevated ferritin levels and the diagnosis of hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 2008;50(6):1227–1235. DOI: 10.1002/pbc.21423.
  10. Ho C, Yao X, Tian L, et al. Marrow assessment for hemophagocytic lymphohistiocytosis demonstrates poor correlation with disease probability. Am J Clin Pathol 2014;141(1):62–71. DOI: 10.1309/AJCPMD5TJEFOOVBW.
  11. Singh ZN, Rakheja D, Yadav TP, et al. Infection-associated haemophagocytosis: the tropical spectrum. Clin Lab Haematol 2005;27(5):312–315. DOI: 10.1111/j.1365-2257.2005.00717.x.
  12. Non LR, Patel R, Esmaeeli A, et al. Typhoid fever complicated by hemophagocytic lymphohistiocytosis and rhabdomyolysis. Am J Trop Med Hyg 2015;93(5):1068–1069. DOI: 10.4269/ajtmh.15-0385.
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