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Secondary HLH Case Report Highlighting Clinical Challenges.
Riad El Fakih1, Said Y Mohamed1, Randa Alnounou1
1King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia.
Case Reports in Hematology
|April 25, 2018
Summary
A patient with relapsed acute myeloid leukemia (AML) developed hemophagocytic lymphohistiocytosis (HLH) after chemotherapy. A late-identified mycobacterial infection complicated the HLH, highlighting diagnostic challenges in critically ill patients.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Acute myeloid leukemia (AML) is a hematologic malignancy.
- Salvage chemotherapy is used for relapsed AML.
- Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome.
Observation:
- A 19-year-old AML patient developed severe cytopenia, jaundice, and fever post-chemotherapy.
- Bone marrow biopsy showed hemophagocytosis, leading to HLH diagnosis and treatment.
- Mycobacterial infection was unexpectedly identified post-mortem from bronchoalveolar lavage.
Findings:
- The case highlights the diagnostic challenges in identifying HLH triggers.
- Delayed identification of the mycobacterial infection likely impacted treatment efficacy.
- The patient's HLH progressed rapidly despite treatment.
Implications:
- Timely diagnosis of HLH triggers is crucial for effective, targeted therapy.
- Infections, including mycobacterial, should be considered in HLH workup.
- This case underscores the need for comprehensive diagnostics in complex hematologic malignancies.
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