Haemophagocytic lymphohistiocytosis complicating Hodgkin's lymphoma in an HIV-positive individual.
We report the case of an HIV-positive man who presented with pyrexia of unknown origin. Histological specimens from an inguinal lymph node and liver biopsy gave a diagnosis of Epstein Barr virus (EBV)-positive Hodgkin's lymphoma and haemophagocytic lymphohistiocytosis (HLH), respectively. HLH is a condition characterized by proliferation of activated macrophages that phagocytose leukocytes, erythrocytes and platelets. Clinical features include splenomegaly, fever and pancytopenia, all of which have a wide differential diagnosis in HIV-positive patients. HLH can be caused by infections, malignancy, drugs or autoimmune conditions. There have been a number of reports of HLH in HIV-positive patients, and it can be seen at all stages of HIV infection. HIV, lymphomas, EBV infection and haemophagocytic syndrome have a complicated pathophysiology. Unfortunately, HLH in this setting has a particularly aggressive course, often with a poor outcome. This case highlights the need for awareness of the syndrome to ensure prompt diagnosis and instigation of appropriate treatment.
Department of Genitourinary Medicine, Whittall Street Clinic, Birmingham B4 6DH, UK. sarahflew@doctors.org.uk
S J
SJ
Flew
K W
KW
Radcliffe
D001706:Biopsy; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000473:pathology; D005335:Fever of Unknown Origin; D015658:HIV Infections / Q000150:complications*; D006651:Histocytochemistry; D006689:Hodgkin Disease / Q000150:complications* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D051359:Lymphohistiocytosis, Hemophagocytic / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008853:Microscopy; D008875:Middle Aged