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Haemophagocytic lymphohistiocytosis secondary to Epstein-Barr and cytomegalovirus coinfection
  1. Ali Zagham Nasir1 and
  2. Nasir Khan2
  1. 1Internal Medicine Residency, Trinity Health West Michigan Library Services, Grand Rapids, Michigan, USA
  2. 2Trinity Health Grand Rapids, Grand Rapids, Michigan, USA
  1. Correspondence to Dr Ali Zagham Nasir; ali.nasir{at}


Haemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening disorder caused by uncontrolled activation of the immune system, leading to phagocytosis of blood cells and cytokine storm. HLH can manifest in childhood due to a genetic mutation, but in adults HLH arises secondary to viral infections, autoimmune diseases or neoplastic processes. The most common viral infections associated with HLH are Epstein-Barr virus (EBV) and cytomegalovirus (CMV). EBV and CMV coinfection associated with HLH, however, is exceedingly rare. We present a case of HLH secondary to EBV and CMV coinfection in a young adult who presented with recurrent intermittent high-grade fevers and epistaxis. This case illustrates the importance of considering HLH in patients with idiopathic fevers and to consider all the potential aetiologies for HLH to ensure proper treatment.

  • Haematology (incl blood transfusion)
  • Rheumatology
  • Infectious diseases
  • Medical management
  • Immunology

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  • Contributors All authors were directly involved in care. NK gathered consent. AZN wrote manuscript and gathered information. NK reviewed and agreed. AZN was responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content. Both authors gave final approval 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.

  • 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.