Case report: Hemorrhagic fever with renal syndrome presenting as hemophagocytic lymphohistiocytosis

Maarten A J De Smet; Simon Bogaert; Alexander Schauwvlieghe; Amélie Dendooven; Pieter Depuydt; Patrick Druwé

doi:10.3389/fmed.2022.1096900

Case report: Hemorrhagic fever with renal syndrome presenting as hemophagocytic lymphohistiocytosis

Front Med (Lausanne). 2022 Dec 12:9:1096900. doi: 10.3389/fmed.2022.1096900. eCollection 2022.

Authors

Maarten A J De Smet¹, Simon Bogaert¹, Alexander Schauwvlieghe², Amélie Dendooven³, Pieter Depuydt¹, Patrick Druwé¹

Affiliations

¹ Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
² Department of Hematology, Ghent University Hospital, Ghent, Belgium.
³ Department of Pathology, Ghent University Hospital, Ghent, Belgium.

Abstract

Hemophagocytic lymphohistiocytosis may occur in patients with genetic predisposition and in sporadic cases due to malignancy or infection. We describe a 49-year old man with hemorrhagic fever, type 1 respiratory insufficiency and acute kidney injury. Diagnostic work up showed a hyperinflammatory syndrome, hypertriglyceridemia, hemophagocytosis, very high ferritin and significantly elevated sCD25. The findings were compatible with hemophagocytic lymphohistiocytosis based on the HLH-2004 criteria. Serological testing indentified Puumala virus as the causal pathogen. The patient was successfully treated with pulse corticosteroids, intravenous immunoglobins and supportive therapy.

Keywords: communicable diseases Puumala virus-associated hemophagocytosis; critical care; hantavirus; hemophagocytic lymphohistiocytosis; hemorrhagic fever with renal syndrome.

Publication types

Case Reports