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Hemophagocytic lymphohistiocytosis in a child with human immunodeficiency virus infection – a case report

Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare condition and furthermore human immunodeficiency virus (HIV)-associated HLH is rarely reported in the literature. The most frequent presentation of secondary HLH is in association with infections, malignancies or drugs. In HIV-positive...

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Autores principales: Chiperi, Lăcrămioara-Eliza, Ionescu, Andra Diana, Marcu, Cristian Tiberiu, Itu-Mureşan, Corina, Pantelemon, Cristina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Academy of Medical Sciences, Romanian Academy Publishing House, Bucharest 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8597364/
https://www.ncbi.nlm.nih.gov/pubmed/34609432
http://dx.doi.org/10.47162/RJME.62.1.29
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author Chiperi, Lăcrămioara-Eliza
Ionescu, Andra Diana
Marcu, Cristian Tiberiu
Itu-Mureşan, Corina
Pantelemon, Cristina
author_facet Chiperi, Lăcrămioara-Eliza
Ionescu, Andra Diana
Marcu, Cristian Tiberiu
Itu-Mureşan, Corina
Pantelemon, Cristina
author_sort Chiperi, Lăcrămioara-Eliza
collection PubMed
description Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare condition and furthermore human immunodeficiency virus (HIV)-associated HLH is rarely reported in the literature. The most frequent presentation of secondary HLH is in association with infections, malignancies or drugs. In HIV-positive patients, the viral infection itself or the antiretroviral therapy (ART) could trigger HLH. Case presentation: A 14-year-old boy was admitted for persistent diarrhea, severe weight loss and chest burns. Laboratory tests revealed important neutropenia, which led to HIV infection diagnosis. ART in combination was started associated with granulocyte-colony stimulating factor. Viral copies declined after six weeks of treatment, but the cluster of differentiation 4 (CD4) T-lymphocytes and neutrophil counts remained very low. Infections and malignancies were ruled out. The bone marrow aspirate revealed hemophagocytosis which in association with fever, bicytopenia, hypofibrinogenemia and hypertriglyceridemia established HLH diagnosis. Cortisone therapy and intravenous immunoglobulins were added. Due to lack of response, HLH-2004 protocol was initiated in collaboration with pediatric hematologist. In the first six months of treatment, CD4 T-lymphocytes and neutrophil count remained low and then they showed significant increase simultaneously. During treatment, the patient developed spontaneous severe back pain. Magnetic resonance imaging showed vertebral compression, osteomalacia and a thoracic vertebral fracture. Conclusions: Having ruled out the usual associated infections and malignancies, this is a case of HIV-associated with HLH. In this case, only the ART and immunomodulatory therapy were not enough and failed to work. Systemic immunosuppression also worked only after a prolonged course which led to an unfortunate complication: a vertebral fracture.
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spelling pubmed-85973642021-12-01 Hemophagocytic lymphohistiocytosis in a child with human immunodeficiency virus infection – a case report Chiperi, Lăcrămioara-Eliza Ionescu, Andra Diana Marcu, Cristian Tiberiu Itu-Mureşan, Corina Pantelemon, Cristina Rom J Morphol Embryol Case Report Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare condition and furthermore human immunodeficiency virus (HIV)-associated HLH is rarely reported in the literature. The most frequent presentation of secondary HLH is in association with infections, malignancies or drugs. In HIV-positive patients, the viral infection itself or the antiretroviral therapy (ART) could trigger HLH. Case presentation: A 14-year-old boy was admitted for persistent diarrhea, severe weight loss and chest burns. Laboratory tests revealed important neutropenia, which led to HIV infection diagnosis. ART in combination was started associated with granulocyte-colony stimulating factor. Viral copies declined after six weeks of treatment, but the cluster of differentiation 4 (CD4) T-lymphocytes and neutrophil counts remained very low. Infections and malignancies were ruled out. The bone marrow aspirate revealed hemophagocytosis which in association with fever, bicytopenia, hypofibrinogenemia and hypertriglyceridemia established HLH diagnosis. Cortisone therapy and intravenous immunoglobulins were added. Due to lack of response, HLH-2004 protocol was initiated in collaboration with pediatric hematologist. In the first six months of treatment, CD4 T-lymphocytes and neutrophil count remained low and then they showed significant increase simultaneously. During treatment, the patient developed spontaneous severe back pain. Magnetic resonance imaging showed vertebral compression, osteomalacia and a thoracic vertebral fracture. Conclusions: Having ruled out the usual associated infections and malignancies, this is a case of HIV-associated with HLH. In this case, only the ART and immunomodulatory therapy were not enough and failed to work. Systemic immunosuppression also worked only after a prolonged course which led to an unfortunate complication: a vertebral fracture. Academy of Medical Sciences, Romanian Academy Publishing House, Bucharest 2021 2021-09-22 /pmc/articles/PMC8597364/ /pubmed/34609432 http://dx.doi.org/10.47162/RJME.62.1.29 Text en Copyright © 2020, Academy of Medical Sciences, Romanian Academy Publishing House, Bucharest https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open-access article distributed under the terms of a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Public License, which permits unrestricted use, adaptation, distribution and reproduction in any medium, non-commercially, provided the new creations are licensed under identical terms as the original work and the original work is properly cited.
spellingShingle Case Report
Chiperi, Lăcrămioara-Eliza
Ionescu, Andra Diana
Marcu, Cristian Tiberiu
Itu-Mureşan, Corina
Pantelemon, Cristina
Hemophagocytic lymphohistiocytosis in a child with human immunodeficiency virus infection – a case report
title Hemophagocytic lymphohistiocytosis in a child with human immunodeficiency virus infection – a case report
title_full Hemophagocytic lymphohistiocytosis in a child with human immunodeficiency virus infection – a case report
title_fullStr Hemophagocytic lymphohistiocytosis in a child with human immunodeficiency virus infection – a case report
title_full_unstemmed Hemophagocytic lymphohistiocytosis in a child with human immunodeficiency virus infection – a case report
title_short Hemophagocytic lymphohistiocytosis in a child with human immunodeficiency virus infection – a case report
title_sort hemophagocytic lymphohistiocytosis in a child with human immunodeficiency virus infection – a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8597364/
https://www.ncbi.nlm.nih.gov/pubmed/34609432
http://dx.doi.org/10.47162/RJME.62.1.29
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