Logo American Journal of Case Reports

Call: 1.631.629.4328
Mon-Fri 10 am - 2 pm EST

Contact Us

Logo American Journal of Case Reports Logo American Journal of Case Reports Logo American Journal of Case Reports

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 A

DOI: 10.12659/AJCR.934092

Am J Case Rep 2021; 22:e934092

Table 1. Clinical course and laboratory findings.

InterventionDay 1Day 2Day 3Day 5Reference
Methylprednisolone Blood cultures drawn Piperacillin/tazobactam startedPlasmapheresis Blood culture grew MSSAHLH suspected Plasmapheresis Anakinra started Antibiotics deescalated to cefazolinBone Marrow Biopsy Hydroxychloroquine started
WBC, K/mm1.561.531.041.37
RBC, M/mm4.433.343.563.21
Hgb, g/dL12.39.510.110.5
Reticulocyte count0.2%
Plt, K/mm77514878
BUN, mg/dL1221019166
Cr, mg/dL 8.264.722.471.82
Na, mEq/L133
Anion gap17
AST, U/L406266140212
ALT, U/L128916389
Lipase, U/L323
C3, mg/dL38
C4, mg/dL9.4
ESR, mm/hr347824
dsDNA ab, IU/mL11990
ANA1: 3240
LDH, U/L1900
Haptoglobin, mg/dL2
D-dimer, ng/dL47 582
Fibrinogen, mg/dL199
Ferritin, ng/dL>16 5009023
Triglycerides, mg/dL399
Urine protein, mg/dL175
Urine Na, mEq/L13
Urine Cr, mg/dL272
* Baseline Cr 0.94 in 2018. Highlighted are notable trends and values that increased our patient’s HScore.
InterventionDay 7Day 8Day 10Day 16Reference
Renal biopsySolumedrol startedEtoposide and tocilizumab startedDay of discharge
WBC, K/mm1.200.952.331.32
RBC, M/mm3.282.943.002.75
Hgb, g/dL8.88.98.37.6
Reticulocyte count
Plt, K/mm84877645
BUN, mg/dL42363221
Cr, mg/dL 1.050.971.030.82
Na, mEq/L
Anion gap
AST, U/L20317311051
ALT, U/L118904632
Lipase, U/L
C3, mg/dL
C4, mg/dL
ESR, mm/hr30
dsDNA ab, IU/mL
ANA
LDH, U/L
Haptoglobin, mg/dL
D-dimer, ng/dL
Fibrinogen, mg/dL
Ferritin, ng/dL943011295>16 5003307
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.

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

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