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Haemophagocytic lymphohistiocytosis (HLH)-associated stress cardiomyopathy secondary to autoimmune conditions successfully treated with anakinra
  1. Muhammad Khalid,
  2. Abuelmagd Abdalla,
  3. Geraldine McCarthy and
  4. John Stack
  1. Rheumatology Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
  1. Correspondence to Dr Abuelmagd Abdalla; dr_abuelmagd{at}


We describe two young cases of reactive haemophagocytic lymphohistiocytosis (HLH) with the resultant stress cardiomyopathy in the setting of underlying autoimmune diseases, systemic lupus erythematosus (SLE) and Still’s disease. The initial presentation was similar in both cases with fever, hyperinflammatory response, hypotension (vasoplegia), bicytopenia and hyperferritinemia. Despite standard of care and multiple broad-spectrum antibiotics, both cases remained pyrexic and were ultimately admitted to the intensive therapy unit to treat cardiogenic shock. Echocardiogram of both cases showed low ejection fraction, the cause for which was not found until the final diagnosis of HLH was made. Both cases made a complete clinical and cardiac recovery following the initiation of high-dose glucocorticoids and anakinra.

  • connective tissue disease
  • biological agents
  • immunology
  • haematology (incl blood transfusion)

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  • Contributors MK devised the manuscript. AA redrafted and revised the manuscript. JS was the primary clinician. JS and GM proofread, reviewed and approved the manuscript for its scientific content.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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