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Haemophagocytic lymphohistiocytosis complicating visceral leishmaniasis in the UK: a case for detailed travel history, a high index of suspicion and timely diagnostics
  1. Sarah May Johnson1,2,
  2. Kimberly Gilmour3,4,
  3. Sujith Samarasinghe5 and
  4. Alasdair Bamford1,4
  1. 1 Paediatric Infectious Diseases, Great Ormond Street Hospital, London, UK
  2. 2 Paediatric Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK
  3. 3 Immunology, Great Ormond Street Hospital, London, UK
  4. 4 Infection, Immunity, Inflammation, Great Ormond Street Institute of Child Health, London, UK
  5. 5 Haematology, Great Ormond Street Hospital, London, UK
  1. Correspondence to Dr Sarah May Johnson, sarahmay.johnson{at}


A 4-month-old male infant presented acutely unwell with fever. He was initially treated for sepsis but failed to improve with IV broad spectrum antibiotics. Haemophagocytic lymphohistiocytosis (HLH) was diagnosed due to his fever, pancytopenia, splenomegaly, hypertriglyceridaemia, hypofibrinogenaemia and significant hyperferritinaemia. An array of differentials for HLH including both immunological and infectious causes were considered and excluded. He had travelled to Madrid, and hence visceral leishmaniasis (VL) was suspected, but was not confirmed on the initial bone marrow aspirate (BMA) microscopy or culture. He improved with empirical treatment with dexamethasone and liposomal amphotericin B. VL was later confirmed on BMA PCR. He made a good recovery and remained well at 12 month follow-up. Non-endemic countries need rapid and sensitive VL diagnostics. A thorough travel history and high clinical index of suspicion are necessary to avoid the pitfall of treatment with intense immunosuppression recommended in treatment guidelines for HLH.

  • global health
  • haematology (incl blood transfusion)
  • immunology
  • infectious diseases
  • tropical medicine (infectious disease)
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  • Contributors SMJ and AB responsible for constructing and drafting case report. KG and SS responsible for interpretation of results. AB, SS and KG responsible for review, revisions and final approval of version for publication. All authors have agreed to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

  • Funding This research was supported by the NIHR.

  • Competing interests None declared.

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

  • Patient consent for publication Parental/guardian consent obtained.

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