Secondary hemophagocytic lymphohistiocytosis in a patient with severe leptospirosis: a case report

Hemophagocytic lymphohistiocytosis is a rare but life-threatening hyperinflammatory syndrome that can be triggered by infections, malignancies, and autoimmune diseases.

We present a case of hemophagocytic lymphohistiocytosis secondary to severe leptospirosis in a 59-year-old Latin American male with no medical history of relevance, which is rarely reported in the literature. One week prior to admission, the patient presented with frontal headache, fever, hyporexia, choluria, jaundice, and hepatomegaly. Sepsis was initially suspected. After antibiotic therapy, his condition deteriorated, leading to acute kidney injury and respiratory failure. Serology and dark-field microscopy in urine and blood were requested and reported positive for Leptospira. Bone marrow aspiration confirmed hemophagocytic lymphohistiocytosis. Treatment with corticosteroids led to clinical and laboratory improvement.

This case highlights the need for early recognition of hemophagocytic lymphohistiocytosis in patients with sepsis-like syndromes unresponsive to standard therapy.