title: Prolonged hemophagocytic lymphohistiocytosis syndrome as an initial presentation of Hodgkin lymphoma: a case report.
abstract: BACKGROUND
  Hemophagocytic lymphohistiocytosis is an immune-mediated syndrome that typically has a rapidly progressive course that can result in pancytopenia, coagulopathy, multi-system organ failure and death.
  
  
  METHODS
  A 57-year-old Caucasian woman was referred in fulminant hemophagocytic lymphohistiocytosis, with fever, pancytopenia, splenomegaly, mental status changes and respiratory failure. She was found to have stage IV classical Hodgkin lymphoma, in addition to Epstein-Barr virus and cytomegalovirus viremia. Her presentation was preceded by a 3-year prodrome consisting of cytopenia and fever that were partially controlled by steroids and azathioprine.
  
  
  CONCLUSIONS
  Fulminant hemophagocytic lymphohistiocytosis may follow a prodromal phase that possesses features suggestive of a chronic form of hemophagocytic lymphohistiocytosis, but which may also resemble immune cytopenias of other causes. A diagnosis of hemophagocytic lymphohistiocytosis should be considered in the setting of chronic pancytopenia.
authors.affiliation: Cardeza Foundation for Hematologic Research and Kimmel Cancer Center, Philadelphia, PA, USA. katrchan@gmail.com
authors.forename: Kathryn
authors.initials: K
authors.lastname: Chan
authors.forename: Eric
authors.initials: E
authors.lastname: Behling
authors.forename: David S
authors.initials: DS
authors.lastname: Strayer
authors.forename: William S
authors.initials: WS
authors.lastname: Kocher
authors.forename: Scott K
authors.initials: SK
authors.lastname: Dessain