title: Fulminant hemophagocytic lymphohistiocytosis induced by pandemic A (H1N1) influenza: a case report.
abstract: BACKGROUND
  Hemophagocytic lymphohistiocytosis induced by viral diseases is a well recognized entity. Severe forms of H5N1 influenza are known to be associated with symptoms very similar to a reactive hemophagocytic syndrome. We report a case of fulminant lymphohistiocytosis associated with the pandemic A (H1N1) variant.
  
  
  METHODS
  A 42-year-old Caucasian woman developed a syndrome of fatal hemophagocytic lymphohistiocytosis shortly after H1N1 influenza. Initial symptoms of the viral disease were unusual, with acute abdominal involvement. Our patient's course was complicated by diffuse skin rash and ileal ischemia. Our patient died of refractory shock and multi-organ failure. Skin, ileum and colon histology was consistent with an acute apoptosis combined with an increased cellular regeneration.
  
  
  CONCLUSIONS
  Influenza may be complicated by severe forms of hemophagocytic lymphohistiocytosis. To ensure early recognition and treatment, physicians should be aware of the possible induction of the syndrome by the novel H1N1 variant. The rapid occurrence of a multi-organ involvement with evocative biological features of macrophage activation should alert clinicians.
authors: Service de Réanimation Polyvalente, Hôpital Roger Salengro, Rue Emile Laine, CHRU, Lille, France. francois.fourrier@chru-lille.fr.
authors: Christophe
authors: C
authors: Willekens
authors: Aurélie
authors: A
authors: Cornelius
authors: Mary-Jane
authors: MJ
authors: Guerry
authors: Agnès
authors: A
authors: Wacrenier
authors: François
authors: F
authors: Fourrier