Hemophagocytic lymphohistiocytosis due to Streptococcus suis in a 12-year-old girl: A case report

RATIONALE: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome that can be caused by bacterial infection. Streptococcus suis (S. suis) is a zoonotic pathogen that can cause severe disease in both pigs and humans. We report the first-ever documented case of HLH secondary to S. suis infection. PATIENT CONCERNS: A 12-year-old girl presented with fever, rash, hepatosplenomegaly, pancytopenia, and elevated levels of ferritin and soluble CD25. Bone marrow examination revealed hemophagocytosis. Blood culture was positive for S. suis. DIAGNOSIS: A diagnosis of hemophagocytic syndrome due to S. suis was established. INTERVENTIONS: We treated the patient with intravenous immunoglobulin, intravenous imipenem, and supportive care. OUTCOMES: The patient eventually showed complete recovery. LESSONS: Inflammatory response plays an important role in S. suis infection. Aberrant inflammatory response to S. suis infection may induce HLH. This case report illustrates that early definitive diagnosis and prompt treatment is a key imperative in patients with suspected S. suis infection.