SHM Converge Scientific Abstract ePoster Gallery-Chasing THR Storm: Hemophagocytic Lymphohistiocytosis With Acute Cholecystitis.

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This case describes a 23-year-old man with granulomatosis with polyangiitis on azathioprine who presented with fever, weight loss, and pancytopenia. Because sepsis was strongly suspected, he was started on broad-spectrum antibiotics and underwent an extensive infectious workup, but no clear infection or malignancy was found. Bone marrow biopsy showed hypocellular marrow without hemophagocytosis. His condition worsened despite treatment, and he later developed abdominal pain, elevated liver enzymes, splenomegaly, and imaging findings consistent with acute acalculous cholecystitis.<br /><br />HLH was then considered because he met clinical criteria, especially in the setting of ongoing deterioration and overlapping features with sepsis. Dexamethasone was started according to the HLH protocol, leading to marked improvement within 24–48 hours.<br /><br />The report emphasizes that HLH can mimic sepsis and that a thorough infectious evaluation is essential. It also highlights that abdominal pain and/or liver test abnormalities in HLH should raise suspicion for acalculous cholecystitis. Early initiation of corticosteroids and immunosuppressive therapy may be lifesaving, may improve gallbladder inflammation by controlling the cytokine-driven immune response, and may be preferable to early surgical intervention.

Asset Subtitle

Faiza Javed

Meta Tag

Author List Faiza Javed

Category Clinical Vignettes

Concept Hemophagocytic Lymphohistiocytosis

Concept Acalculous Cholecystitis

Concept Glucocorticoid Therapy

Concept Sepsis

Concept Abdominal Pain

Distinguished Non-Finalist

Presenter Organization University of Kentucky

Presenting Author Faiza Javed

Track Adult

Keywords

hemophagocytic lymphohistiocytosis

HLH

sepsis mimic

granulomatosis with polyangiitis

azathioprine

pancytopenia

dexamethasone

acalculous cholecystitis

splenomegaly

bone marrow biopsy

Hemophagocytic Lymphohistiocytosis

Acalculous Cholecystitis

Glucocorticoid Therapy

Sepsis

Abdominal Pain