06 October 2021>: Articles
Hemophagocytic Lymphohistiocytosis Triggered by Leishmaniasis: A Case Report and Literature Review
Challenging differential diagnosis, Diagnostic / therapeutic accidents, Rare disease
Stefka Neycheva A* , Boycho Oparanov B , Adriana Kamburova A , Rositsa Karalilova A , Vera Stoeva ADOI: 10.12659/AJCR.933012
Am J Case Rep 2021; 22:e933012
Table 1. Laboratory results.
Time frame | Complete blood count | Reference ranges | Coagulation | Reference ranges | Chemistry | Reference ranges |
---|---|---|---|---|---|---|
Two weeks after first symptoms, the patient was admitted to the Department of Infectious Diseases | WBC 4.34×10/l | 3.5–10.5 | DD 20.0 µg/ml | 0.5 | CRP 163.4 mg/L | 0–5 |
RBC 4.04×10/l | 4.2–5.4 | PT time 63% | 70–130 | ALAT 24.4 U/l | 5–40 | |
HGB 96.0 g/l | 120–160 | INR 1.37 | 0.7–1.3 | Amylase 22.0 U/l | 30–100 | |
ESR 33 mm/h | 0–15 | PT time 16.2 s | 10–14 | ASAT 76.6 U/l | 5–40 | |
PLT 90 ×10/l | 140–440 | APTT 30.6 s | 28–40 | |||
Six days later, the patient was hospitalized in the Department of Rheumatology | WBC 2.85 109/l | 3.5–10.5 | DD 20.0 µg/ml | 0.5 | CRP 139.3 mg/L | 0–5 |
RBC 3.2 1012/l | 4.2–5.4 | PT time 61% | 70–130 | Total protein 53.5 g/l | 63–85 | |
HGB 77.0 g/l | 120–160 | INR 1.4 | 0.7–1.3 | Ferritin 1110.0 ug/l | 10–120 | |
HCT 0.244 l/l | 0.36–0.46 | PT time 16.5 s | 10–14 | ASAT 111.4 U/l | 5–40 | |
PLT 69×10/l | 140–440 | APTT 36.0 s | 28–40 | ALAT 42.1 U/l | 5–40 | |
ESR 20 mm/h | 0–15 | FIB 1.92g/l | 2–4.5 | LDH 1294.0 U/L | 208–378 | |
Three days after last infusion of IVIG (600 mg/kg divided in 3 days) | WBC 4.48×10/l | 3.5–10.5 | DD >20.0 µg/ml | 0.5 | CRP 115.8 mg/L | 0–5 |
RBC 3.35×10/l | 4.2–5.4 | PT time 68% | 70–130 | Ferritin 1083.0 µg/l | 10–300 | |
HGB 80.0 g/l | 120–160 | INR 1.3 | 0.7–1.3 | ASAT 69.8 U/l | 5–40 | |
PLT 72×10/l | 140–440 | PT time 15.6 s | 10–14 | ALAT 35.7 U/l | 5–40 | |
ESR 37 mm/h | 0–15 | FIB 2.48 g/l | 2–4.5 | |||
Three days after last infusion of MPR (1 g daily for 3 days) | WBC 3.41×10/l | 3.5–10.5 | DD 19.99 µg/ml | 0.5 | CRP 101.8 mg/L | 0–5 |
RBC 2.96×10/l | 4.2–5.4 | PT time 75% | 70–130 | Ferritin 887.0 ug/l | 10–120 | |
HGB 69.0 g/l | 120–160 | INR 1.21 | 0.7–1.3 | TG 2.35 mmol/l | 0.30–2.10 | |
PLT 138×10/l | 140–440 | PT time 14.8 s | 10–14 | ASAT 136.5 U/l | 5–40 | |
ESR 66 mm/h | 0–15 | FIB 2.25g/l | 2–4.5 | ALAT 59.9 U/l | 5–40 | |
Three days after initiation of treatment with cyclosporine A 50 mg twice daily | WBC 5.56×10/l | 3.5–10.5 | DD 2.06 µg/ml | 0.5 | CRP 16.0 mg/L | 0–5 |
RBC 3.88×10/l | 4.2–5.4 | PT time 103% | 70–130 | Ferritin 393.0 ug/l | 10–120 | |
HGB 92.0 g/l | 120–160 | INR 0.98 | 0.7–1.3 | LDH 691.0 U/L | 208–378 | |
PLT 278×10/l | 140–440 | PT time 12.6 s | 10–14 | ASAT 54.6 U/l | 5–40 | |
ESR 74 mm/h | 0–15 | FIB 3.22 g/l | 2–4.5 | ALAT 81.1 U/l | 5–40 | |
Seven days after increasing the dose of cyclosporine A to 100 mg twice daily | WBC 9.56×10/l | 3.5–10.5 | DD 0.73 µg/ml | 0.5 | CRP 0.2 mg/L | 0–5 |
RBC 4.02×10/l | 4.2–5.4 | PT time 113% | 70–130 | Ferritin 80.0 ug/l | 10–120 | |
HGB 96.0 g/l | 120–160 | INR 0.93 | 0.7–1.3 | LDH 352.0 U/L | 208–378 | |
PLT 305×10/l | 140–440 | PT time 12.1 s | 10–14 | ASAT 24.7 U/l | 5–40 | |
ESR 49 mm/h | 0–15 | FIB 2.73 g/l | 2–4.5 | ALAT 45.8 U/l | 5–40 | |
Two months later: relapse of the disease was accompanied with worsening of the laboratory findings | WBC 3.27/l | 3.5–10.5 | DD 20.0 µg/ml | 0.5 | CRP 236.1 mg/L | 0–5 |
RBC 3.85/l | 4.2–5.4 | PT time 80% | 70–130 | Total protein 69.6 g/l | 63–85 | |
HGB 89.0 g/l | 120–160 | INR 1.16 | 0.7–1.3 | Ferritin 637.0 µg/ml | 10–300 | |
PLT 171 | 140–440 | PTtime 14.3 s | 10–14 | ASAT 44.6 U/l | 5–40 | |
ESR 80 | 0–15 | FIB 5.37g/l | 2.0–4.5 | ALAT 20.3 U/l | 5–40 | |
ESR – erythrocyte sedimentation rate; WBC – white blue cells; PLT – platelets; HGB –hemoglobin; HCT – hematocrit; MCV – mean cell volume; MCH – mean cell hemoglobin; ASAT – aspartate aminotransferase; ALAT – alanine aminotransferase; TG – triglycerides; LDH – lactate dehydrogenase; PT – time-prothrombin time; INR – international normalized ratios; APTT – activated partial thromboplastin time; DD – D-dimers; FIB – fibrinogen; IVIG – intravenous immunoglobulin; MPR – methylprednisolone. |