SHM Converge Scientific Abstract ePoster Gallery-Hemophagocytic Lymphohistiocytosis (Hlh) Associated With Disseminated Toxoplasmosis in an Immunocompetent Individual

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This case report describes a 41-year-old immunocompetent man who developed severe disseminated toxoplasmosis complicated by hemophagocytic lymphohistiocytosis (HLH) and died despite broad medical workup and treatment. He was admitted with acute renal failure, myalgias, anuria, shortness of breath, high fevers, and tachycardia. Imaging showed enteritis, mediastinal lymphadenopathy, and a small pleural effusion, but cultures, echocardiography, tagged WBC scan, and pleural studies did not identify an infectious source. Despite escalating antibiotics, his fevers persisted, and hematology was consulted because of marked hyperferritinemia (ferritin 10,000) and concern for HLH or malignancy.<br /><br />During hospitalization, he developed encephalopathy and mild aphasia; neuroimaging was unrevealing. Before further diagnostic procedures could be completed, he suffered multiple PEA cardiac arrests, required ICU care and vasopressors, and later expired. Autopsy revealed disseminated Toxoplasma gondii infection involving multiple organs, including the heart, liver, and brain, along with evidence of hemophagocytosis in lymph nodes consistent with HLH. A left psoas hemorrhage was also noted, likely related to a hypocoagulable state. His altered mental status was thought to be due to toxoplasma encephalitis, and myocardial and hepatic involvement were also documented.<br /><br />The report emphasizes that disseminated toxoplasmosis can occur even in immunocompetent individuals and may trigger HLH, a life-threatening hyperinflammatory syndrome. Because infection-associated HLH can rapidly worsen prognosis, clinicians should consider HLH when patients have persistent fever, cytopenias, and markedly elevated ferritin, and they should aggressively search for and treat the underlying infectious trigger early.

Asset Subtitle

Hassan H. Allahrakha

Meta Tag

Author List Hassan H. Allahrakha, Leigh Hunter

Category Clinical Vignettes

Concept Toxoplasmosis

Concept HLH-MAS

Concept HLH-04 criteria

Concept H-score

Concept Infection

Distinguished Non-Finalist

Presenter Organization Methodist Dallas Medical Center

Presenting Author Hassan H. Allahrakha

Track Adult

Keywords

disseminated toxoplasmosis

Toxoplasma gondii

hemophagocytic lymphohistiocytosis

HLH

immunocompetent

hyperferritinemia

encephalopathy

multiorgan involvement

autopsy

infection-associated HLH

Toxoplasmosis

HLH-MAS

HLH-04 criteria

H-score

Infection