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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 A

DOI: 10.12659/AJCR.933012

Am J Case Rep 2021; 22:e933012

Table 1. Laboratory results.

Time frameComplete blood countReference rangesCoagulationReference rangesChemistryReference ranges
Two weeks after first symptoms, the patient was admitted to the Department of Infectious DiseasesWBC 4.34×10/l3.5–10.5DD 20.0 µg/ml0.5CRP 163.4 mg/L0–5
RBC 4.04×10/l4.2–5.4PT time 63%70–130ALAT 24.4 U/l5–40
HGB 96.0 g/l120–160INR 1.370.7–1.3Amylase 22.0 U/l30–100
ESR 33 mm/h0–15PT time 16.2 s10–14ASAT 76.6 U/l5–40
PLT 90 ×10/l140–440APTT 30.6 s28–40
Six days later, the patient was hospitalized in the Department of RheumatologyWBC 2.85 109/l3.5–10.5DD 20.0 µg/ml0.5CRP 139.3 mg/L0–5
RBC 3.2 1012/l4.2–5.4PT time 61%70–130Total protein 53.5 g/l63–85
HGB 77.0 g/l120–160INR 1.40.7–1.3Ferritin 1110.0 ug/l10–120
HCT 0.244 l/l0.36–0.46PT time 16.5 s10–14ASAT 111.4 U/l5–40
PLT 69×10/l140–440APTT 36.0 s28–40ALAT 42.1 U/l5–40
ESR 20 mm/h0–15FIB 1.92g/l2–4.5LDH 1294.0 U/L208–378
Three days after last infusion of IVIG (600 mg/kg divided in 3 days)WBC 4.48×10/l3.5–10.5DD >20.0 µg/ml0.5CRP 115.8 mg/L0–5
RBC 3.35×10/l4.2–5.4PT time 68%70–130Ferritin 1083.0 µg/l10–300
HGB 80.0 g/l120–160INR 1.30.7–1.3ASAT 69.8 U/l5–40
PLT 72×10/l140–440PT time 15.6 s10–14ALAT 35.7 U/l5–40
ESR 37 mm/h0–15FIB 2.48 g/l2–4.5
Three days after last infusion of MPR (1 g daily for 3 days)WBC 3.41×10/l3.5–10.5DD 19.99 µg/ml0.5CRP 101.8 mg/L0–5
RBC 2.96×10/l4.2–5.4PT time 75%70–130Ferritin 887.0 ug/l10–120
HGB 69.0 g/l120–160INR 1.210.7–1.3TG 2.35 mmol/l0.30–2.10
PLT 138×10/l140–440PT time 14.8 s10–14ASAT 136.5 U/l5–40
ESR 66 mm/h0–15FIB 2.25g/l2–4.5ALAT 59.9 U/l5–40
Three days after initiation of treatment with cyclosporine A 50 mg twice dailyWBC 5.56×10/l3.5–10.5DD 2.06 µg/ml0.5CRP 16.0 mg/L0–5
RBC 3.88×10/l4.2–5.4PT time 103%70–130Ferritin 393.0 ug/l10–120
HGB 92.0 g/l120–160INR 0.980.7–1.3LDH 691.0 U/L208–378
PLT 278×10/l140–440PT time 12.6 s10–14ASAT 54.6 U/l5–40
ESR 74 mm/h0–15FIB 3.22 g/l2–4.5ALAT 81.1 U/l5–40
Seven days after increasing the dose of cyclosporine A to 100 mg twice dailyWBC 9.56×10/l3.5–10.5DD 0.73 µg/ml0.5CRP 0.2 mg/L0–5
RBC 4.02×10/l4.2–5.4PT time 113%70–130Ferritin 80.0 ug/l10–120
HGB 96.0 g/l120–160INR 0.930.7–1.3LDH 352.0 U/L208–378
PLT 305×10/l140–440PT time 12.1 s10–14ASAT 24.7 U/l5–40
ESR 49 mm/h0–15FIB 2.73 g/l2–4.5ALAT 45.8 U/l5–40
Two months later: relapse of the disease was accompanied with worsening of the laboratory findingsWBC 3.27/l3.5–10.5DD 20.0 µg/ml0.5CRP 236.1 mg/L0–5
RBC 3.85/l4.2–5.4PT time 80%70–130Total protein 69.6 g/l63–85
HGB 89.0 g/l120–160INR 1.160.7–1.3Ferritin 637.0 µg/ml10–300
PLT 171140–440PTtime 14.3 s10–14ASAT 44.6 U/l5–40
ESR 800–15FIB 5.37g/l2.0–4.5ALAT 20.3 U/l5–40
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.

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923