SHM Converge Scientific Abstract ePoster Gallery-Hemophagocytic Lymphohistiocytosis Triggered by Hodgkin Lymphoma: A Diagnostic and Therapeutic Challenge

Pdf Summary

This case describes hemophagocytic lymphohistiocytosis (HLH), a rare, rapidly progressive hyperinflammatory syndrome that can be triggered by hematologic malignancies such as Hodgkin lymphoma. HLH is difficult to diagnose because patients may not meet all classic criteria, especially when critically ill or malnourished. In adults, HLH commonly occurs with hematologic cancers, but Hodgkin lymphoma accounts for fewer than 10% of cases.<br /><br />A 42-year-old woman with recently diagnosed nodular sclerosing Hodgkin lymphoma presented after syncope with severe cachexia and malnutrition. She arrived hypotensive, tachycardic, and febrile, and was treated for distributive and hypovolemic shock with vasopressors and broad-spectrum antibiotics in the ICU. Her condition worsened with jaundice, lactic acidosis, thrombocytopenia, and respiratory failure requiring intubation.<br /><br />By day three, labs showed ferritin of 13,059 ng/mL, hemoglobin 8.7 g/dL, platelets 7,000/μL, fibrinogen 160 mg/dL, and triglycerides 106 mg/dL. Imaging revealed splenomegaly. Although hypertriglyceridemia was absent, clinicians suspected HLH and began chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine. She later developed anuric renal failure requiring plasmapheresis and continuous renal replacement therapy, and received multiple blood product transfusions. Despite aggressive treatment, she died. Postmortem testing showed markedly elevated interleukin-2 receptor alpha.<br /><br />The report emphasizes that HLH may present atypically, particularly in malnourished patients, and that absence of hypertriglyceridemia does not exclude the diagnosis. Early recognition, high clinical suspicion, and prompt empiric treatment are essential. Standard therapy includes corticosteroids, etoposide, and malignancy-directed chemotherapy when tolerated, though etoposide could not be given in this unstable patient.

Asset Subtitle

Mark Soliman

Meta Tag

Author List Ardit Feinaj, Mark Soliman, Mohamed Swalih, Saif Memon

Category Clinical Vignettes

Concept Secondary hemophagocytic lymphohistiocytosis

Concept HLH-04 criteria

Concept Hodgkin Lymphoma

Concept Corticosteroids

Concept BEP Chemotherapy

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Health

Presenting Author Mark Soliman

Track Adult

Keywords

hemophagocytic lymphohistiocytosis

HLH

Hodgkin lymphoma

hyperinflammatory syndrome

ferritin

splenomegaly

thrombocytopenia

malnutrition

critical illness

etoposide

Secondary hemophagocytic lymphohistiocytosis

HLH-04 criteria

Hodgkin Lymphoma

Corticosteroids

BEP Chemotherapy