title: Hemophagocytic Lymphohistiocytosis After Initiation of Chemotherapy for Bilateral Adrenal Neuroblastoma.
abstract: Hemophagocytic lymphohistiocytosis (HLH) is a rare and aggressive syndrome characterized by overactivation of the immune system. Although secondary HLH has been frequently associated with malignancies, this entity is rarely triggered by solid tumors, such as neuroblastomas. Herein, we describe a 14-month-old girl with a late diagnosis of bilateral adrenal neuroblastoma who developed HLH 6 days after the initiation of chemotherapy. On the basis of the large tumoral mass and the time of onset of her symptoms suggestive of HLH, we hypothesize that tumor cell destruction induced by chemotherapy drugs was the trigger to the development of hematophagocytic lymphohistiocytosis syndrome.
authors.affiliation: *Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada †Department of Pediatrics, Pequeno Príncipe Hospital ‡Department of Pediatrics, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil.
authors.forename: Fábio A
authors.initials: FA
authors.lastname: Nascimento
authors.forename: Juliane
authors.initials: J
authors.lastname: Nery
authors.forename: Joanna
authors.initials: J
authors.lastname: Trennepohl
authors.forename: Mara A D
authors.initials: MA
authors.lastname: Pianovski
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000188:drug therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007223:Infant; D051359:Lymphohistiocytosis, Hemophagocytic / Q000139:chemically induced*; D009447:Neuroblastoma / Q000188:drug therapy*; D013713:Teniposide / Q000008:administration & dosage / Q000009:adverse effects; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D013713:Teniposide