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  • Safe usage of anakinra and dexamethasone to treat refractory hemophagocytic lymphohistiocytosis secondary to acute disseminated histoplasmosis in a patient with HIV/AIDS

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CASE REPORT
Safe usage of anakinra and dexamethasone to treat refractory hemophagocytic lymphohistiocytosis secondary to acute disseminated histoplasmosis in a patient with HIV/AIDS
  1. Anthony J Ocon1,
  2. Birju D Bhatt1,
  3. Cynthia Miller2,
  4. Ruben A Peredo3
  1. 1Division of Rheumatology, Department of Medicine, Albany Medical Center, Albany, New York, USA
  2. 2Division of Infectious Disease, Department of Medicine, Albany Medical Center, Albany, New York, USA
  3. 3Department of Internal Medicine, Albany Medical Center, Albany, New York, USA
  1. Correspondence to Dr Birju D Bhatt, bhattb30{at}gmail.com

Summary

Hemophagocytic lymphohistiocytosis (HLH) is a serious life-threatening disease if not recognised early. In patients with HIV/AIDS, this association has been reported following acute opportunistic infections, including histoplasmosis. However, optimal treatment is not known. We describe a male aged 46 years with AIDS who developed HLH following acute disseminated histoplasmosis. Presenting symptoms included fever, hepatosplenomegaly and pancytopenia. Bone marrow biopsy confirmed HLH. Initially, he was refractory to the treatment with amphotericin B, antiretroviral therapy and intravenous immunoglobulin (IVIG). Anakinra, an interleukin-1 receptor antagonist, and dexamethasone were initiated. He improved clinically, did not exhibit any harmful effects and ultimately was discharged from the hospital. This, we believe, is the first reported treatment of HLH with anakinra in a patient with AIDS and acute disseminated histoplasmosis.

  • haematology (incl blood transfusion)
  • hiv / aids
  • biological agents
  • rheumatology

https://doi.org/10.1136/bcr-2017-221264

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    Footnotes

    • Contributors When this patient was admitted to the hospital, there were four people involved in the patient’s case. AJO was the medical resident who was taking care of the patient on the floor. BDB was the rheumatology fellow involved in the patient care while the patient was admitted to the hospital. RAP was the rheumatology attending overseeing BDB and the patient when he was admitted to the hospital. CM was the HIV-infectious disease specialist involved in the care of the patient in both the inpatient and outpatient setting. All the authors were involved in writing this case report. All the authors were involved in writing the summary, background, the case presentation, investigations, differential diagnosis, treatment, outcome and discussion/learning point. All the authors approved the final version of the draft to be submitted. All the authors are responsible for the overall content as guarantors. All the authors do not have any financial disclosures.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.