title: Hemophagocytic lymphohistiocytosis with a leukemoid reaction in an infant with scrub typhus.
abstract: A two-month-old male infant presented with a clinical picture suggestive of fever without focus. Treatment was initiated with broad spectrum intravenous antibiotics. The infant subsequently developed septic shock, hepatosplenomegaly and tachypnoea with oxygen dependency. There was laboratory evidence of anemia, thrombocytopenia and a leukemoid reaction. Infection induced hemophagocytic lymphohistiocytosis with a leukemoid reaction was suspected because of fever, splenomegaly and bicytopenia in conjunction with elevated serum triglycerides and ferritin. Empiric therapy with doxycycline caused a rapid resolution of the fever, and the diagnosis of scrub typhus was confirmed by a positive scrub IgM ELISA. HLH with a leukemoid reaction secondary to scrub typhus has not previously been reported in early infancy.
authors.affiliation: Department of Paediatrics, ESIC Medical College & PGIMSR, K.K. Nagar, Chennai 600 078, Tamil Nadu, India. Electronic address: drsunithapazhani@gmail.com.
authors.forename: Sunitha
authors.initials: S
authors.lastname: Pazhaniyandi
authors.affiliation: Department of Paediatrics, ESIC Medical College & PGIMSR, K.K. Nagar, Chennai 600 078, Tamil Nadu, India.
authors.forename: Ramamoorthi
authors.initials: R
authors.lastname: Lenin
authors.affiliation: Department of Paediatrics, ESIC Medical College & PGIMSR, K.K. Nagar, Chennai 600 078, Tamil Nadu, India.
authors.forename: Shobhana
authors.initials: S
authors.lastname: Sivathanu
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004318:Doxycycline / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007955:Leukemoid Reaction / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D012612:Scrub Typhus / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline
keywords: Hemophagocytic lymphohistiocytosis; Infant; Leukemoid reaction; Scrub typhus