The Rheumatologist
COVID-19 NewsACR Convergence
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Gout Resource Center
      • Axial Spondyloarthritis Resource Center
      • Psoriatic Arthritis
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Fellows’ Forum Case Report: Hemophagocytic Lymphohistiocytosis

Fellows’ Forum Case Report: Hemophagocytic Lymphohistiocytosis

August 13, 2017 • By Anita Laloo, MB, BS, MPH, German Pihan, MD, & Robert H. Shmerling, MD

  • Tweet
  • Email
Print-Friendly Version / Save PDF

The patient was a 48-year-old woman who saw her primary care physician for a flu-like illness three months prior to admission. Her symptoms initially improved, but recurred one month later; she was treated symptomatically, and again symptoms resolved.

You Might Also Like
  • Fellows’ Forum Case Report: Autoinflammatory Diseases and Roles of Genetic, Molecular Testing
  • Fellows Forum Case Report: Neuromyelitis Optica
  • Fellows’ Forum Case Report: Progressive Multifocal Leukoencephalopathy and RA
Explore This Issue
August 2017

Two months later, she presented to an outside facility’s emergency department with fever to 103ºF, with associated chills, night sweats, headache, fatigue, abdominal pain and arthralgias, which became progressively more severe over one week. She reported having daily fever with headache, fatigue, malaise, myalgias and abdominal pain. There was no recent travel. Her episodes of abdominal discomfort were intermittent and primarily located in the epigastrium and left upper quadrant, without associated nausea, vomiting or diarrhea. Her arthralgias were localized to the bilateral metacarpophalangeal and proximal interphalangeal joints. Review of systems was otherwise negative.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Her past medical history was unremarkable, and she was up to date with routine health maintenance screening, including mammograms and pap smears. The only medication she was taking was acetaminophen for fever and arthralgias. She reported an allergy to penicillin. She had no family history of rheumatic disease. She lived with her husband and had four children. She had quit smoking 15 years earlier, but previously she’d had a 7.5 pack–year history of smoking.

At the outside hospital, she was found to be pancytopenic. This led to an extensive workup that was unrevealing, including tests for EBV, CMV, CMP, leptospira, parvovirus, toxoplasmosis, Babesia, anaplasma, Ehrlichia, Bartonella, influenza and Lyme disease, CT chest/abdomen/pelvis and a bone marrow biopsy. She was transferred to our medical center for additional evaluation.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Upon arrival, she was febrile to 102.2ºF, with a heart rate of 100 beats per minute, blood pressure of 90–100/40–50, and a respiratory rate of 24 with normal oxygen saturation on room air. She was pale in appearance. Her abdomen was soft with tenderness in the left upper quadrant and epigastrium, and the spleen was palpable. Her musculoskeletal exam revealed tenderness at the metacarpophalangeal and proximal interphalangeal joints of both hands, without swelling.

Laboratory studies included a white blood cell count of 2.4 K/µL, hemo­globin of 6.7 g/dL and platelet count of 84 K/µL. Her CRP was elevated to 90 mg/L and her ESR was 33 mm/h. Her ferritin was 543 ng/mL and triglyceride was

325 mg/dL. The remainder of her labs were unremarkable. She had a negative serological workup for ANA, ANCA, RF, anti-CCP and antibodies to RNP, Jo-1, Ro and La. SPEP revealed no abnormalities.

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

Pages: 1 2 3 4 5 6 | Single Page

Filed Under: Conditions Tagged With: breast, case report, Clinical, Diagnosis, fever, hemophagocytic lymphohistiocytosis, immunodeficiency, lymphoma, malignancy, outcome, patient care, Research, rheumatology, symptoms, TreatmentIssue: August 2017

You Might Also Like:
  • Fellows’ Forum Case Report: Autoinflammatory Diseases and Roles of Genetic, Molecular Testing
  • Fellows Forum Case Report: Neuromyelitis Optica
  • Fellows’ Forum Case Report: Progressive Multifocal Leukoencephalopathy and RA
  • Fellows’ Forum Case Report: Necrotizing Autoimmune Myopathy

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use / Cookie Preferences

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2023 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)