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[When cognitive biases lead to diagnostic errors].

Thea Ziswiler1, Christine Roten1, Carole E Aubert1

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Summary
This summary is machine-generated.

A severe case of hemophagocytic lymphohistiocytosis (HLH) was triggered by visceral leishmaniasis, not a lymphoproliferative disorder. Careful clinical reasoning and awareness of cognitive biases are crucial for diagnosing rare diseases.

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Area of Science:

  • Hematology
  • Infectious Diseases
  • Internal Medicine

Background:

  • A 62-year-old patient presented with severe hemophagocytic lymphohistiocytosis (HLH).
  • The patient was admitted to a hemato-oncology ward for presumed lymphoproliferative disorder (LPD).
  • Initial assessments lacked clear evidence for LPD.

Purpose of the Study:

  • To report a rare case of HLH triggered by visceral leishmaniasis.
  • To highlight the impact of cognitive biases on clinical decision-making in complex cases.
  • To emphasize the importance of thorough clinical reasoning in diagnosing rare diseases.

Main Methods:

  • Case report of a 62-year-old patient.
  • Serum PCR for identifying the HLH trigger.
  • Analysis of clinical management and diagnostic process.

Main Results:

  • Visceral leishmaniasis was identified as the cause of HLH via serum PCR.
  • Several near-miss incidents occurred due to physician cognitive biases.
  • The presumed LPD diagnosis was incorrect.

Conclusions:

  • Visceral leishmaniasis can present as a trigger for HLH.
  • Cognitive biases can significantly impair patient management in complex rare diseases.
  • Awareness of cognitive biases and rigorous clinical reasoning are essential before invasive procedures and treatment initiation.