HAEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS AS A COMPLICATION OF VIRAL INFECTION IN A CHILD- CASE REPORT
Abstract
Introduction and objective: Haemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening hyperinflammatory syndrome that may follow viral infections. We present a case of a 12-month-old boy who developed disseminated intravascular coagulation (DIC) and fulfilled HLH diagnostic criteria following influenza A virus infection. Extensive diagnostics excluded a genetic cause. Treatment based on the HLH-2018 protocol led to full recovery. This case emphasizes the importance of considering HLH in infants with severe systemic inflammation and coagulopathy, even in the absence of EBV infection. Early recognition and appropriate therapy are essential to improve outcomes.
Results. This case report describes a 12-month-old boy with haemophagocytic lymphohistiocytosis (HLH) and disseminated intravascular coagulation (DIC) following influenza A infection. Despite negative genetic testing, the patient met HLH diagnostic criteria. Treatment per HLH-2018 protocol was successful. The case underscores the importance of early recognition of HLH in viral infections beyond Epstein-Barr virus.
References
Adelborg K, Larsen JB, Hvas A-M. Disseminated intravascular coagulation: epidemiology, biomarkers, and management. Br J Haematol 2021;192:803–18. https://doi.org/10.1111/bjh.17172.
Al-Samkari H, Berliner N. Hemophagocytic Lymphohistiocytosis. Annual Review of Pathology: Mechanisms of Disease 2018;13:27–49. https://doi.org/10.1146/annurev-pathol-020117-043625.
Chu R, van Eeden C, Suresh S, Sligl WI, Osman M, Cohen Tervaert JW. Do COVID-19 Infections Result in a Different Form of Secondary Hemophagocytic Lymphohistiocytosis. Int J Mol Sci 2021;22:2967. https://doi.org/10.3390/ijms22062967.
Demircioğlu F, Kazancı E, Genç DB, Erdoğan H, Bilir Göksügür S, Bekdaş M. H1N1 Infection-Related Hemophagocytic Lymphohistiocytosis in a Child. Turk J Haematol 2013;30:426–8. https://doi.org/10.4274/Tjh.2013.0022.
Fukunaga S, Ishida C, Nakaoka A, Ito T. A case of acute kidney injury and disseminated intravascular coagulation associated with influenza B viral infection. CEN Case Rep 2014;4:95–100. https://doi.org/10.1007/s13730-014-0147-9.
Gao J, Pasion J, Sanchez-Petitto G, Law J. Influenza virus B-associated hemophagocytic lymphohistiocytosis. Hematol Rep 2019;11:8268. https://doi.org/10.4081/hr.2019.8268.
Griffin G, Shenoi S, Hughes GC. Hemophagocytic lymphohistiocytosis: An update on pathogenesis, diagnosis, and therapy. Best Pract Res Clin Rheumatol 2020;34:101515. https://doi.org/10.1016/j.berh.2020.101515.
Hayden A, Park S, Giustini D, Lee AYY, Chen LYC. Hemophagocytic syndromes (HPSs) including hemophagocytic lymphohistiocytosis (HLH) in adults: A systematic scoping review. Blood Reviews 2016;30:411–20. https://doi.org/10.1016/j.blre.2016.05.001.
Imashuku S, Morimoto A, Ishii E. Virus-triggered secondary hemophagocytic lymphohistiocytosis. Acta Paediatr2021;110:2729–36. https://doi.org/10.1111/apa.15973.
Jayashree K, Rao S, Kamath N. Influenza B Virus Triggering Macrophage Activation Syndrome in an Infant. Indian J Crit Care Med 2017;21:802–3. https://doi.org/10.4103/0972-5229.218137.
Padhi S, Varghese RGB, Ramdas A, Phansalkar MD, Sarangi R. Hemophagocytic lymphohistiocytosis: critical reappraisal of a potentially under-recognized condition. Front Med 2013;7:492–8. https://doi.org/10.1007/s11684-013-0292-0.
P K, D L, B D, J M, B B, H B. Secondary Hemophagocytic Lymphohistiocytosis in Post-COVID-19 Patients: A Report of Two Cases. Cureus 2021;13. https://doi.org/10.7759/cureus.17328.
Retamozo S, Brito-Zerón P, Sisó-Almirall A, Flores-Chávez A, Soto-Cárdenas M-J, Ramos-Casals M. Haemophagocytic syndrome and COVID-19. Clin Rheumatol 2021;40:1233–44. https://doi.org/10.1007/s10067-020-05569-4.
Valade S, Azoulay E, Galicier L, Boutboul D, Zafrani L, Stepanian A, et al. Coagulation Disorders and Bleedings in Critically Ill Patients With Hemophagocytic Lymphohistiocytosis. Medicine (Baltimore) 2015;94:e1692. https://doi.org/10.1097/MD.0000000000001692.
Xu L, Guo X, Guan H. Serious consequences of Epstein-Barr virus infection: Hemophagocytic lymphohistocytosis. International Journal of Laboratory Hematology 2022;44:74–81. https://doi.org/10.1111/ijlh.13736.
Views:
5
Downloads:
2
Copyright (c) 2025 Marianna Chmiel, Artur Tumiński, Gabriela Kapłon, Weronika Perczyńska, Julia Szczotka, Gabriela Szpila, Aleksandra Sokół, Anna Kamieniak, Karolina Glajcar, Remigiusz Flakus, Żaneta Kania, Dominika Gieroba

This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.

