[Secondary hemophagocytic lymphohistiocytosis due to icteric leptospirosis with acute renal failure].

Abstract

A 51-year-old patient presented himself with fever, upper abdominal pain and exertional dyspnea. Hemodynamic instability accompanied by generalized icterus, hepatosplenomegaly, a morbilliform rash with petechia and bilateral conjunctivitis revealed in clinical examination.Laboratory results revealed elevated C-reactive protein and procalcitonin as well as pancytopenia and hyperbilirubinemia. Furthermore hypertriglyceridemia, hyperferritinemia and elevated soluble IL-2-receptor were found. Testing for infectious diseases detected IgM-antibodies to leptospires. Bone marrow cytology featured hemophagocytosis.Secondary hemophagocytic lymphohistiocytosis due to icteric leptospirosis (Weil's disease) was diagnosed.Immediate antibiotic therapy and circulatory support by fluid and vasopressors was initiated and non-invasive ventilation and hemodialysis stabilized the patient. With steroids and polyvalent immunoglobulins the organ functions recovered.Hemophagocytic lymphohistiocytosis is an important differential or concomitant diagnosis in sepsis and can be induced by rarely diagnosed infectious triggers like leptospirosis.