09 November 2021>: Articles
Prompt Recognition of Hemophagocytic Lymphohistiocytosis in an Afebrile Patient with Lupus and Bacteremia
Challenging differential diagnosis, Management of emergency care, Rare coexistence of disease or pathology
Joshua Hardage A , Natalie B. Otto A , Joanne Skaggs E* , Stephen Travis ADOI: 10.12659/AJCR.934092
Am J Case Rep 2021; 22:e934092
Table 1. Clinical course and laboratory findings.
Intervention | Day 1 | Day 2 | Day 3 | Day 5 | Reference |
---|---|---|---|---|---|
Methylprednisolone Blood cultures drawn Piperacillin/tazobactam started | Plasmapheresis Blood culture grew MSSA | HLH suspected Plasmapheresis Anakinra started Antibiotics deescalated to cefazolin | Bone Marrow Biopsy Hydroxychloroquine started | ||
WBC, K/mm | 1.56 | 1.53 | 1.04 | 1.37 | |
RBC, M/mm | 4.43 | 3.34 | 3.56 | 3.21 | |
Hgb, g/dL | 12.3 | 9.5 | 10.1 | 10.5 | |
Reticulocyte count | 0.2% | ||||
Plt, K/mm | 77 | 51 | 48 | 78 | |
BUN, mg/dL | 122 | 101 | 91 | 66 | |
Cr, mg/dL | 8.26 | 4.72 | 2.47 | 1.82 | |
Na, mEq/L | 133 | ||||
Anion gap | 17 | ||||
AST, U/L | 406 | 266 | 140 | 212 | |
ALT, U/L | 128 | 91 | 63 | 89 | |
Lipase, U/L | 323 | ||||
C3, mg/dL | 38 | ||||
C4, mg/dL | 9.4 | ||||
ESR, mm/hr | 34 | 78 | 24 | ||
dsDNA ab, IU/mL | 119 | 90 | |||
ANA | 1: 3240 | ||||
LDH, U/L | 1900 | ||||
Haptoglobin, mg/dL | 2 | ||||
D-dimer, ng/dL | 47 582 | ||||
Fibrinogen, mg/dL | 199 | ||||
Ferritin, ng/dL | >16 500 | 9023 | |||
Triglycerides, mg/dL | 399 | ||||
Urine protein, mg/dL | 175 | ||||
Urine Na, mEq/L | 13 | ||||
Urine Cr, mg/dL | 272 | ||||
* Baseline Cr 0.94 in 2018. Highlighted are notable trends and values that increased our patient’s HScore. | |||||
Intervention | Day 7 | Day 8 | Day 10 | Day 16 | Reference |
Renal biopsy | Solumedrol started | Etoposide and tocilizumab started | Day of discharge | ||
WBC, K/mm | 1.20 | 0.95 | 2.33 | 1.32 | |
RBC, M/mm | 3.28 | 2.94 | 3.00 | 2.75 | |
Hgb, g/dL | 8.8 | 8.9 | 8.3 | 7.6 | |
Reticulocyte count | |||||
Plt, K/mm | 84 | 87 | 76 | 45 | |
BUN, mg/dL | 42 | 36 | 32 | 21 | |
Cr, mg/dL | 1.05 | 0.97 | 1.03 | 0.82 | |
Na, mEq/L | |||||
Anion gap | |||||
AST, U/L | 203 | 173 | 110 | 51 | |
ALT, U/L | 118 | 90 | 46 | 32 | |
Lipase, U/L | |||||
C3, mg/dL | |||||
C4, mg/dL | |||||
ESR, mm/hr | 30 | ||||
dsDNA ab, IU/mL | |||||
ANA | |||||
LDH, U/L | |||||
Haptoglobin, mg/dL | |||||
D-dimer, ng/dL | |||||
Fibrinogen, mg/dL | |||||
Ferritin, ng/dL | 9430 | 11295 | >16 500 | 3307 | |
Triglycerides, mg/dL | |||||
Urine protein, mg/dL | |||||
Urine Na, mEq/L | |||||
Urine Cr, mg/dL | |||||
* Baseline Cr 0.94 in 2018. Highlighted are notable trends and values that increased our patient’s HScore. |