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Critical care
Haemophagocytic lymphohistiocytosis (HLH) secondary to disseminated histoplasmosis infection in a patient with HIV
  1. Joel Thomas Zimmerman1,
  2. Courtney Hanson1 and
  3. Alfredo Iardino2
  1. 1Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
  2. 2Critical Care, Pulmonology, CHI St Alexius Health Bismarck Medical Center, Bismarck, North Dakota, USA
  1. Correspondence to Mr Joel Thomas Zimmerman; joel.zimmerman{at}und.edu

Abstract

A male in his 30s who was recently diagnosed with HIV arrived at the emergency department exhibiting an altered mental state and acute respiratory distress. Initial laboratory tests revealed a high anion gap metabolic acidosis, elevated liver enzyme levels and bicytopenia. A CT scan identified a miliary pattern. Bronchoscopy with bronchoalveolar lavage displayed epithelial and inflammatory cells. However, subsequent tests ruled out the presence of fungi, Pneumocystis organisms, malignancies, granulomas and viral inclusions. Broad-spectrum antibiotics with emphasis on Mycobacterium tuberculosis and antifungal treatments were administered. The regimen was adjusted after a positive urine test for the Histoplasma antigen.

The patient later manifested signs and symptoms, including increased ferritin level, fever, splenomegaly, diminished natural killer cell function and heightened interleukin-2 receptor levels, confirming haemophagocytic lymphohistiocytosis. Given the patient’s gravely decompensated state, the treatment incorporated dexamethasone, and the patient’s vasopressor-resistant septic shock was addressed with methylene blue.

  • Infections
  • Immunology
  • HIV / AIDS
  • Adult intensive care
  • TB and other respiratory infections

https://doi.org/10.1136/bcr-2023-259484

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    Footnotes

    • X @IadinoPCCM

    • Contributors The following authors were responsible for drafting the text, sourcing and editing clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: JTZ, CH and AI. The following authors gave final approval of the manuscript: JTZ, CH and AI.

    • 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.