Pediatric CNS-isolated hemophagocytic lymphohistiocytosis

OBJECTIVE: To highlight a novel, treatable syndrome, we report 4 patients with CNS-isolated inflammation associated with familial hemophagocytic lymphohistiocytosis (FHL) gene mutations (CNS-FHL). METHODS: Retrospective chart review. RESULTS: Patients with CNS-FHL are characterized by chronic inflammation restricted to the CNS that is not attributable to any previously described neuroinflammatory etiology and have germline mutations in known FHL-associated genes with no signs of systemic inflammation. Hematopoietic stem cell transplantation (HCT) can be well tolerated and effective in achieving or maintaining disease remission in patients with CNS-FHL. CONCLUSIONS: Early and accurate diagnosis followed by treatment with HCT can reduce morbidity and mortality in CNS-FHL, a novel, treatable syndrome. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that HCT is well tolerated and effective in treating CNS-FHL.