SHM Converge Scientific Abstract ePoster Gallery-Double Trouble: Hemophagocytic Lymphohistiocytosis Induced by Newly Diagnosed Hodgkins Lymphoma

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A 26-year-old man with virally suppressed HIV presented with 3 weeks of fevers, night sweats, chills, cough, weakness, hypotension, and tachycardia. Exam showed cervical and axillary lymphadenopathy, and CT imaging revealed splenomegaly with diffuse lymphadenopathy in the supraclavicular, mediastinal, and retroperitoneal regions. His condition worsened to acute hypoxic respiratory failure and presumed septic shock, requiring ICU care with intubation and vasopressors.<br /><br />Laboratory studies showed pancytopenia, elevated inflammatory markers, hypertriglyceridemia, markedly increased ferritin, elevated LDH, and a very high soluble CD25 level. These findings raised concern for hemophagocytic lymphohistiocytosis (HLH). Bone marrow biopsy confirmed EBV-positive classical Hodgkin’s lymphoma, establishing the trigger for secondary HLH.<br /><br />The patient met 5 of the 8 HLH diagnostic criteria, including fever, splenomegaly, cytopenias, hypertriglyceridemia, and elevated ferritin/soluble CD25. Antibiotics were stopped after infection became less likely, and treatment with dexamethasone and induction chemotherapy for Hodgkin’s lymphoma was started, leading to clinical improvement.<br /><br />The case highlights that HLH is a rare but often fatal hyperinflammatory syndrome that can mimic septic shock and multiorgan failure. In adults, it is commonly secondary to infections, autoimmune disease, drugs, or malignancy, especially lymphoma. The authors emphasize that prolonged fever, cytopenias, and splenomegaly should prompt early evaluation for HLH and its underlying cause, since rapid diagnosis and treatment can reduce morbidity and mortality.

Asset Subtitle

Kemar O. Barrett

Meta Tag

Author List Brian H. Kim, Devon Scott, Kemar O. Barrett, Marsha-Marie McLeod, Sofia Terner, Veronica Jacome Lopez

Category Clinical Vignettes

Concept Hemophagocytic Lymphohistiocytosis

Concept HLH-04 criteria

Concept Sepsis

Concept Fever

Concept Hodgkin Lymphoma

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Kemar O. Barrett

Track Adult

Keywords

hemophagocytic lymphohistiocytosis

HLH

EBV-positive Hodgkin lymphoma

secondary HLH

septic shock mimic

pancytopenia

splenomegaly

hyperferritinemia

soluble CD25

dexamethasone chemotherapy

Hemophagocytic Lymphohistiocytosis

HLH-04 criteria

Sepsis

Fever

Hodgkin Lymphoma