Diagnosis of Hemophagocytic Lymphohistiocytosis in Pyrexia of Unknown Origin: A Case Report

TL;DR

A 61-year-old man with a three-month fever was diagnosed with hemophagocytic lymphohistiocytosis through a liver biopsy and PET scan.

Contribution

Highlights the importance of considering hemophagocytic lymphohistiocytosis in cases of unexplained fever in low-resource settings.

Findings

PET scan showed multiple FDG-avid liver lesions, leading to the diagnosis.

The patient exhibited typical symptoms like fever, splenomegaly, and hyperferritinemia.

Early suspicion and diagnosis are critical in resource-limited regions.

Abstract

A case of a 61-year male presented with chief complaints of fever for three months. Diagnosis of hemophagocytic lymphohistiocytosis was made after liver biopsy when Positron-Emission Tomography revealed multiple fluoro deoxy glucose avid lesions in the liver. The patient of this disease typically presents with fever, splenomegaly, hyperferritinemia, hypertriglyceridemia, raised liver enzymes, and marrow features suggestive of hemophagocytosis. The treatment is usually systemic corticosteroids, chemotherapy with etoposide, cyclosporine, or hematopoietic stem cell transplantation, depending on the cause. A diagnosis like hemophagocytic lymphohistiocytosis can easily be missed in developing countries with low resources like Nepal. Hence, this disease should be suspected in patients presenting with pyrexia of unknown origin by treating physicians.

Figures