Rare case of secondary hemophagocytic lymphohistiocytosis in a patient with disseminated histoplasmosis.

Abstract

Upon hospital admission, the patient had a history of fever and lethargy for 11 days. Further history revealed that his father is a farm worker. Initial physical examination showed massive hepatosplenomegaly. Laboratory testing showed pancytopenia and mild elevation of his liver enzymes with Hb 78 g/L, MCV 80 fl, WBC 1.1 × 109/L, ANC 1.2 × 109/L, and platelet count of 110 × 109/L. Abdominal computer tomography confirmed the hepatosplenomegaly. Additional laboratory tests showed ferritin 830 ng/ml, fibrinogen 1.32 mg/L, triglycerides 2.13 mg/L, soluble interlukin-2 (IL-2) receptor 9560 Units/ml, and negative human immunodeficiency virus (HIV) serology.