Sudden Cardiac Arrest Due to Hemophagocytic Lymphohistiocytosis in a Child

Area of Science:

• Pediatric Emergency Medicine
• Pediatric Critical Care
• Pediatric Hematology-Oncology

Background:

• Hemophagocytic lymphohistiocytosis (HLH) is a rare pediatric hyperinflammatory syndrome.
• HLH can present with symptoms mimicking septic shock.
• Sudden out-of-hospital cardiac arrest in children is uncommon and often has an unclear initial cause.

Observation:

• A previously healthy 10-year-old experienced sudden cardiac arrest.
• The child had a preceding insidious course of sore throat, fever, and altered mental status.
• The patient was diagnosed with Epstein-Barr virus-associated HLH.

Findings:

• Epstein-Barr virus-associated HLH was identified as the cause of sudden cardiac arrest in this pediatric case.
• The child developed cerebral edema and ultimately died.
• This represents the first reported case of HLH causing sudden out-of-hospital cardiac arrest in a child.

Implications:

• Emergency physicians must consider HLH in the differential diagnosis of sudden pediatric cardiac arrest.
• Prompt diagnosis of HLH can guide critical therapeutic interventions.
• Timely management may improve the chances of salvaging organ function in children with HLH.