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Case report
Desperate times, desperate measures: successful use of chemotherapy in treatment of haemophagocytic lymphohistiocytosis (HLH) due to disseminated histoplasmosis
  1. Sunny Rajendra Kumar Singh,
  2. Kannan Thanikachalam and
  3. Vijayalakshmi Donthireddy
  1. Haematology and Oncology, Henry Ford Hospital, Detroit, Michigan, USA
  1. Correspondence to Dr Sunny Rajendra Kumar Singh; ssingh15{at}


We describe a case of haemophagocytic lymphohistiocytosis (HLH) secondary to disseminated histoplasmosis, which was treated with chemotherapy in addition to standard antifungal therapy. While HLH in the setting of infections is very well described, its treatment in this setting is controversial, with some physicians treating only the underlying infection, whereas others using immune suppression in addition to antimicrobials. To the best of our knowledge, this is the first report documenting the successful treatment of an adult patient with HLH due to disseminated histoplasmosis using etoposide chemotherapy after initial antifungal therapy failed to show improvement.

  • haematology (incl blood transfusion)
  • immunology
  • infectious diseases
  • biological agents
  • hepatitis other

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  • Contributors All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content of the manuscript. Specific contributions made by each author are listed below. SRKS: conception of the idea and design, obtaining consent from the patient and drafting the manuscript. KT and SRKS: literature review and analysis. KT and VD: revising the manuscript critically for errors and important intellectual content. VD: approval of the version of the manuscript to be published.

  • 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 for publication Obtained.

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

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