Disseminated infection to immune activation

Area of Science:

• Infectious Diseases
• Rheumatology
• Hematology

Background:

• Rheumatoid arthritis (RA) patients on immunosuppression are susceptible to opportunistic infections.
• Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome.

Observation:

• A 61-year-old woman with RA presented with fever, multiorgan failure, pancytopenia, and elevated ferritin.
• Bone marrow biopsy confirmed HLH.
• Fungal blood cultures identified Histoplasma after initial chemotherapy.

Findings:

• Histoplasma infection was the underlying cause of HLH in this immunosuppressed patient.
• Antifungal therapy was initiated after chemotherapy.
• Successful treatment of Histoplasma-associated HLH was achieved with antifungal agents.

Implications:

• Early recognition of opportunistic infections is crucial in immunosuppressed RA patients.
• HLH should be considered in the differential diagnosis of unexplained fever and organ dysfunction in this population.
• Targeted antifungal therapy is effective for Histoplasma-induced HLH.