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 2. Shown are our patient’s presentation characteristics and how they increase his HScore, and thus his probability of having reactive HLH. Hepatosplenomegaly is based on abdominal ultrasound. Number of lineages with cytopenia is based on WBC <5 K/mm3, platelets <110 K/mm3, and hemoglobin <9.2 g/dL.
| Risk factor | Classification | Points awarded |
|---|---|---|
| Immunosuppression (HIV or immunosuppressive therapy) | No | +0 |
| Yes | +18 | |
| Temperature, ˚C | +0 | |
| 38.4–39.4 | +33 | |
| >39.4 | +49 | |
| Organomegaly | None | +0 |
| Hepatomegaly or splenomegaly | +23 | |
| Hepatosplenomegaly | +38 | |
| Cytopenia | 1 lineage | +0 |
| 2 lineages | +24 | |
| 3 lineages | +34 | |
| Ferritin, ng/mL | 0 | |
| 2000–6000 | +35 | |
| >6000 | +50 | |
| Triglycerides, mg/dL | +0 | |
| 132.7–354 | +44 | |
| >354 | +64 | |
| Fibrinogen, mg/dL | >250 | +0 |
| +30 | ||
| AST, U/L | +0 | |
| >30 | +19 | |
| Hemophagocytosis on bone marrow biopsy | No | +0 |
| Yes | +35 | |