Hemophagocytic Lymphohistiocytosis in a Kidney Transplant Recipient: Case Report

Abstract

Hemophagocytic lymphohistiocytosis is a potentially fatal multisystemic inflammatory syndrome that is better understood in the pediatric population. Consequently, the diagnostic criteria for adults still derives from studies conducted in the pediatric population. Several genetic mutations and secondary causes, including infections, autoimmunity, and malignancy, have been reported as significant actors in this condition, especially in adults. It is of the utmost importance to identify these triggers, as the treatment of this condition is largely dependent on addressing the underlying cause. Those who have undergone transplantation and whose immune response is already compromised are particularly susceptible to this condition. We present the case of a 74-year-old kidney transplant recipient who was admitted due to a persistent fever of unknown origin, pancytopenia, and splenomegaly. The patient was ultimately diagnosed with hemophagocytic lymphohistiocytosis in our hospital secondary to Epstein–Barr virus, aspergillosis, and leishmania infections. Targeted treatments for the aforementioned conditions led to the resolution of the syndrome and the recovery of the patient. Lymphohistiocytosis is a rare, albeit serious, condition that should be considered a differential diagnosis in the early stages of critical illness in transplant recipient patients. Doing so enables target treatments to be administered as soon as possible.