Lymphoma-Associated Hemophagocytic Syndrome (LAHS) Masquerading as Severe Sepsis and Septic Shock

Our case involves a patient who presented with abdominal pain, nausea, and vomiting and was found to have lactic acidosis, acute liver dysfunction, and renal failure. An intra-abdominal infection was initially suspected, but the infectious workup was negative, and he did not respond to antimicrobial therapy. He rapidly deteriorated despite aggressive supportive care. Further workup revealed evidence that his symptoms were being driven by hemophagocytic lymphohistiocytosis (HLH) syndrome of an unclear cause. A liver biopsy was obtained; however, before the pathology results, the patient developed internal hemorrhage due to severe coagulopathy, and he was not able to be resuscitated despite aggressive treatment. The liver biopsy revealed T-cell lymphoma of the liver, most likely a hepatosplenic subtype of lymphoma, which is quite rare compared to the incidence of B-cell lymphomas. Lymphomas can present in a diverse range of presentations and can be accompanied by co-syndromes such as HLH. HLH can cause serious morbidity and mortality through overactivation of the immune system, affecting multiple organ systems. This case demonstrates the need for a broad differential when approaching a patient with multi-organ failure, as malignancy can be the inciting condition, and effective treatment may depend on swift diagnosis.