# Hemophagocytic Lymphohistiocytosis Secondary to Epstein-Barr Virus Infection in an Adolescent Male Patient: A Case Report

## TL;DR

A teenage boy developed a rare blood condition called hemophagocytic lymphohistiocytosis (HLH) due to an Epstein-Barr virus infection and was successfully treated with a combination of medications.

## Contribution

This case report highlights HLH triggered by Epstein-Barr virus in an adolescent and successful treatment with methylprednisolone, anakinra, and intravenous immunoglobulin.

## Key findings

- The patient's HLH was triggered by Epstein-Barr virus infection, presenting with malaise, jaundice, and hearing loss.
- Treatment with methylprednisolone, anakinra, and intravenous immunoglobulin led to significant clinical and biochemical improvement.
- Bone marrow and lymph node biopsies ruled out lymphoma as the cause of the patient's condition.

## Abstract

Hemophagocytic lymphohistiocytosis (HLH) is a severe hematological condition characterized by a wide spectrum of clinical presentations, making diagnosis particularly challenging. Potential triggers include infections, malignancies, autoimmune diseases, and certain medications or interventions. We report a case of HLH in an adolescent male in his late teens triggered by Epstein-Barr virus infection. The initial symptoms were malaise, jaundice, and bilateral hearing loss. On examination, the patient had palpable cervical lymphadenopathy, splenomegaly, and epigastric tenderness. Laboratory investigations showed pancytopenia with elevated ferritin and triglyceride levels. The patient was transferred from a district general hospital to the nearest tertiary center and subsequently admitted to the intensive care unit. Bone marrow and lymph node biopsies were performed to exclude lymphoma. He was successfully treated with methylprednisolone, anakinra (interleukin-1 receptor antagonist), and intravenous immunoglobulin, resulting in marked improvement in symptoms, viral load, and biochemical parameters.