SHM Converge Scientific Abstract ePoster Gallery-Hemophagocytic Lymphohistiocytosis (Hlh) Versus Sepsis : Should Hyperferritinemia Hold More Weight for Timely Diagnosis ?

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This case report argues that <strong>marked hyperferritinemia may be an important early clue for diagnosing HLH rather than sepsis</strong>, especially when other HLH criteria are still pending. HLH is a dangerous syndrome of immune overactivation that can rapidly lead to multiorgan failure, so prompt recognition is critical. However, its presentation often resembles sepsis, making diagnosis difficult in the ICU or emergency setting.

The report describes a 64-year-old man with fever, cough, vomiting, diarrhea, and malaise. His history included rheumatoid arthritis treated with immunomodulating drugs. Initial evaluation showed fever, mild hypoxemia, leukopenia, severe thrombocytopenia, elevated liver enzymes, hypertriglyceridemia, very high LDH, and <strong>ferritin of 20,000 ng/mL</strong>. Infectious testing for SARS-CoV-2, HIV, EBV, and CMV was negative, and chest X-ray was unremarkable. Later testing showed elevated soluble IL-2 receptor levels, supporting HLH.

The authors emphasize that standard diagnostic frameworks such as the <strong>2004 HLH criteria</strong>, <strong>modified 2009 criteria</strong>, and <strong>H-score</strong> can delay treatment because they depend on multiple laboratory results that may not return quickly. In contrast, a very high ferritin level can provide an earlier warning sign and should carry more weight when HLH is suspected.

They also note that management is challenging when <strong>multiple HLH triggers</strong> exist in one patient. In this case, the patient had at least three possible triggers: a respiratory infection, pre-existing autoimmune disease, and an underlying lymphoproliferative disorder discovered during admission. This complexity makes trigger-specific treatment difficult and highlights the need for individualized management.

Asset Subtitle

Pallavi Rohela

Meta Tag

Author List Harold Matos-Casano, Karan Kahlon, Pallavi Rohela

Category Clinical Vignettes

Concept Hyperferritinemia

Concept Hemophagocytic Lymphohistiocytosis

Concept Sepsis

Concept Cytopenia

Concept Secondary hemophagocytic lymphohistiocytosis

Distinguished Non-Finalist

Presenter Organization Brigham and Women's Hospital

Presenting Author Pallavi Rohela

Track Adult

Keywords

hyperferritinemia

hemophagocytic lymphohistiocytosis

HLH

sepsis mimic

ferritin

soluble IL-2 receptor

thrombocytopenia

rheumatoid arthritis

lymphoproliferative disorder

ICU diagnosis

Hyperferritinemia

Hemophagocytic Lymphohistiocytosis

Sepsis

Cytopenia

Secondary hemophagocytic lymphohistiocytosis