title: Acute liver failure caused by hemophagocytic lymphohistiocytosis in adults: A case report and review of the literature.
abstract: BACKGROUND
  Hemophagocytic lymphohistiocytosis (HLH) is a rare condition that can be caused by a primary or acquired disorder of uncontrolled immune response. Liver injury is a common complication of HLH; however, HLH presenting as acute liver failure (ALF) has rarely been reported in adults.
  
  
  METHODS
  A 34-year-old man was admitted to our hospital with nausea and fatigue persisting for 2 weeks and jaundice for 1 week. He had hyperthermia at the onset of disease. At admission, he had severe liver injury with unknown etiology. The laboratory data showed that he had hyperferritinemia, thrombocytopenia, anemia, hypertriglyceridemia, and hypofibrinogenemia. Finally, a bone marrow biopsy revealed hemophagocytic cells, and he was diagnosed with HLH. The patient was treated with prednisone and plasma exchange. However, the liver function of the patient deteriorated, and he finally died of multiorgan failure.
  
  
  CONCLUSIONS
  Reports of adult patients with ALF caused by HLH have increased, and HLH should be suspected in patients with ALF of indeterminate cause. Although the efficacy of the treatment strategy recommended by the HLH 2004 remains to be confirmed in adult patients with ALF caused by HLH, early diagnosis and prompt combined treatment with steroids and cyclosporin A or etoposide should be emphasized.
authors.affiliation: Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical College, Guizhou, China.
authors.forename: Shide
authors.initials: S
authors.lastname: Lin
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.forename: Jun
authors.initials: J
authors.lastname: Long
authors.forename: Qichuan
authors.initials: Q
authors.lastname: Liu
authors.forename: Fangwan
authors.initials: F
authors.lastname: Yang
authors.forename: Yihuai
authors.initials: Y
authors.lastname: He
mesh_terms: D000328:Adult; D001706:Biopsy; D017809:Fatal Outcome; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology*; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications* / Q000175:diagnosis*; D008297:Male