BMJ Case Reports 2018; doi:10.1136/bcr-2018-225592
  • Reminder of important clinical lesson

Cytomegalovirus-associated haemophagocytic lymphohistiocytosis: a rare cause of febrile neutropenia during cancer chemotherapy

  1. Olav Jonas Bergmann1,3
  1. 1Department of Haematology, Vejle Hospital, Vejle, Denmark
  2. 2Department of Pathology, Odense University Hospital, Odense, Denmark
  3. 3Faculty of Health, Aarhus University, Aarhus, Denmark
  1. Correspondence to Dr Olav Jonas Bergmann, Olav.J.Bergmann{at}
  • Accepted 10 August 2018
  • Published 14 September 2018


Febrile neutropenia (FN) is a common complication in patients with cancer during treatment with antineoplastic drugs. The initial cause is usually bacterial, and treatment of FN follows well-defined algorithms. We report a case of a 62-year-old patient with chronic lymphocytic leukaemia (CLL), who developed FN, which was unresponsive to both empirical antibacterial and empirical antifungal therapy. Surprisingly, a diagnosis of the life-threatening condition haemophagocytic lymphohistiocytosis (HLH) associated with cytomegalovirus (CMV) infection was made and treated successfully. CMV-associated HLH has not previously been described in patients with CLL treated with rituximab and bendamustine. It is concluded that HLH should be considered in patients with cancer with FN not responding to conventional antibiotic therapy.


  • Contributors KB is the primary author and was responsible for data acquisition, analysis, interpretation and manuscript preparation. HEHM and OJB participated in data interpretation and manuscript evaluation. All authors read and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

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

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