PT  - JOURNAL ARTICLE
AU  - Saroja Bangaru
AU  - Amanda Strickland
AU  - Dominick Cavuoti
AU  - Nainesh Shah
TI  - HHV-8-associated haemophagocytic lymphohistiocytosis in a patient with advanced AIDS
AID  - 10.1136/bcr-2017-222382
DP  - 2017 Dec 20
TA  - BMJ Case Reports
PG  - bcr-2017-222382
VI  - 2017
4099  - http://casereports.bmj.com/content/2017/bcr-2017-222382.short
4100  - http://casereports.bmj.com/content/2017/bcr-2017-222382.full
AB  - We present a patient with advanced AIDS admitted with recurrent shock of unclear aetiology, fevers, altered mental status and refractory cytopenias. His case posed a diagnostic challenge because evaluation of septic shock in the setting of advanced AIDS requires a time-consuming work-up for broad infectious aetiologies that can delay consideration of other diagnoses, including primary or secondary haemophagocytic lymphohistiocytosis (HLH). After this patient did not improve with supportive care and empiric antimicrobials, there was concern for HLH given that he met ≥5 of the HLH consortium criteria. He underwent bone marrow biopsy, which was non-diagnostic. Empiric therapy for HLH was initiated, but unfortunately, the patient died. Autopsy revealed extensive haemophagocytosis in the spleen, bone marrow and liver, confirming the diagnosis of HLH. Postmortem, his soluble CD-25 returned 18 890 pg/mL (<1033 pg/mL), and his serum HHV-8 PCR resulted positive. The diagnosis was HLH secondary to Human Herpes Virus 8 (HHV-8) in a patient with advanced AIDS.