Case Report


A fatal case of hemophagocytic lymphohistiocytosis in an elderly male

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1 Medical Student, Internal Medicine, Flushing Hospital Medical Center, Flushing, NY, USA

2 Resident, Internal Medicine, Flushing Hospital Medical Center, Flushing, NY, USA

3 Attending Physician, Internal Medicine, Flushing Hospital Medical Center, Flushing Hospital, Flushing, NY, USA

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Maysoon T Hussain

Medical Student, Internal Medicine, Flushing Hospital Medical Center, Flushing, NY

USA

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Article ID: 101458Z01MH2024

doi: 10.5348/101458Z01MH2024CR

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How to cite this article

Hussain MT, Dubey S, Akil M, Gondal N. A fatal case of hemophagocytic lymphohistiocytosis in an elderly male. Int J Case Rep Images 2024;15(1):111–113.

ABSTRACT


We present a case of an 87-year-old male with hemophagocytic lymphohistiocytosis (HLH). Hemophagocytic lymphohistiocytosis is a life-threatening disorder characterized by dysregulated immune activity leading to end-organ damage. Hematologic malignancies appear to be the main cause of secondary HLH. Diagnostic criteria include fever, cytopenia, splenomegaly, hypertriglyceridemia, hypofibrinogenemia, a ferritin level greater than 500 ng/mL, low NK-cell activity, and elevated sIL2Ra levels greater than or equal to 2400 U/mL. Five out of eight of the criteria are necessary to establish a diagnosis of HLH. Our patient met five out of eight diagnostic criteria for HLH (fever, cytopenia, splenomegaly, hypertriglyceridemia, and ferritin level greater than 500 ng/mL). Bone marrow aspirate revealed hemophagocytosis. Bone marrow biopsy revealed marginal zone B cell lymphoma, which is presumed to be the underlying cause of his condition. Due to poor functional status, the patient was a poor candidate for curative treatment, and the family chose not to pursue this route. The patient was treated with Decadron 20 mg intravenous (IV) push daily until he ultimately died, likely due to respiratory failure due to heart failure (HF).

 

Keywords: B cell lymphoma, Cytopenias, Hemophagocytic lymphohistiocytosis, Unexplained fever

SUPPORTING INFORMATION


Author Contributions

Maysoon T Hussain - Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Saurabh Dubey - Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Mohamad Akil - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published

Nasir Gondal - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published

Guarantor of Submission

The corresponding author is the guarantor of submission.

Source of Support

None

Consent Statement

Written informed consent was obtained from the patient for publication of this article.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Conflict of Interest

Authors declare no conflict of interest.

Copyright

© 2024 Maysoon T Hussain 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.


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