title: Familial hemophagocytic lymphohistiocytosis: how late can the onset be?
abstract: OBJECTIVE
  Most patients with familial hemophagocytic lymphohistiocytosis (HLH) develop the disease within the first two years of age. In a minority of cases a later occurrence has been reported, with an upper age limit of eight years. A significant concordance of the age at onset within each family has also been observed.
  
  
  RESULTS
  We report four cases of families with HLH diagnosed at an unusually late age, comprised between between 9 and 17 years; in each of these families another child developed the disease in infancy. The natural killer activity of the patients was depleted; nevertheless, we had indirect evidence that, in at least two families, mutations of the perforin gene were not causing the disease.
  
  
  CONCLUSIONS
  Such a late onset is very unusual and suggests that there is a subgroup of families with HLH in which the disease may present early or late in different members. Thus in some families with HLH the siblings might remain at risk of developing the disease for several years. Their actual risk cannot be defined until the genetic mutation is identified in each family and assessed in each member.
authors: Department of Pediatrics, University, IRCCS Policlinico San Matteo, Pavia, Italy.
authors: M
authors: M
authors: Allen
authors: C
authors: C
authors: De Fusco
authors: F
authors: F
authors: Legrand
authors: R
authors: R
authors: Clementi
authors: V
authors: V
authors: Conter
authors: C
authors: C
authors: Danesino
authors: G
authors: G
authors: Janka
authors: M
authors: M
authors: Aricò
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D005192:Family Health; D005260:Female; D005808:Genes, Recessive; D015616:Histiocytosis, Non-Langerhans-Cell / Q000150:complications / Q000175:diagnosis / Q000235:genetics*; D006801:Humans; D008297:Male