title: Haemophagocytic lymphohistiocytosis: a cause of unresponsive malaria in a 5-year-old girl.
abstract: A 5-year-old immunocompetent girl presented with fever, jaundice, hepatosplenomegaly and pancytopenia. The peripheral blood smear demonstrated mixed malaria infection (Plasmodium vivax and Plasmodium falciparum). Fever was persistent despite antimalarials in the absence of any coexisting bacterial or viral infection. Laboratory findings included cytopaenia, hyperbilirubinaemia, hyperferritinaemia, hypertriglyceridaemia, hyponatraemia, deranged partial thromboplastin time, decreasing ESR and megaloblastic changes on bone marrow aspiration. A final diagnosis of haemophagocytic lymphohistiocytosis (HLH) with megaloblastic anaemia associated with severe mixed malaria was made. There was a dramatic response to corticosteroid treatment with improvement in her clinical condition. This report endorses the use of corticosteroids in malaria-associated HLH whenever there is no clinical improvement with antimalarials alone.
authors.affiliation: Department of Paediatrics, K. J. Somaiya Medical College and Hospital , Mumbai, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Bhagat
authors.forename: Sujata
authors.initials: S
authors.lastname: Kanhere
authors.forename: Purvi
authors.initials: P
authors.lastname: Kadakia
authors.forename: Varsha
authors.initials: V
authors.lastname: Phadke
authors.forename: Riya
authors.initials: R
authors.lastname: George
authors.forename: Kushagra
authors.initials: K
authors.lastname: Chaudhari
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000749:Anemia, Megaloblastic / Q000150:complications* / Q000473:pathology; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use; D001774:Blood Chemical Analysis; D002675:Child, Preschool; D060085:Coinfection / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D016778:Malaria, Falciparum / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D016780:Malaria, Vivax / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D010198:Pancytopenia / Q000175:diagnosis / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000962:Antimalarials
keywords: HLH; Malaria; Megaloblastic anaemia