30 July 2025
: Case report 
Successful Management of Severe Refractory ARDS in Hemophagocytic Lymphohistiocytosis with VV-ECMO: A Case Report and Analysis
Challenging differential diagnosis, Management of emergency care, Rare disease
Mengqi Guan BCDE 1,2, Yan Qian C 3, Zihua Tang F 1,2, Yingya Cao C 1,2,4, Xiaogan Jiang ADG 1,2, Weihua Lu ACG 1,2*, Qiancheng Xu A 1,2,4DOI: 10.12659/AJCR.949154
Am J Case Rep 2025; 26:e949154
Table 2 Assessment of diagnostic criteria for hemophagocytic lymphohistiocytosis.
| Diagnostic criterion | Description | Patient’s value | Criteria fulfilled? |
|---|---|---|---|
| 1. Fever | Body temperature >38.5°C, persisting for >7 days | Body temperature >38.5°C, persisting for >7 days | Yes |
| 2. Splenomegaly | Enlargement of the spleen | Spleen length: 126 mm, thickness: 55 mm | Yes |
| 3. Cytopenias (affecting 2 or more cell lines) | Hemoglobin <90 g/L | 57 g/L | Yes |
| Platelets <100×10/L | 1×10/L | ||
| Neutrophils <1.0×10/L | 0×10/L | ||
| 4. Hypertriglyceridemia or hypofibrinogenemia | Triglycerides >3 mmol/L, | 5.14 mmol/L | Yes |
| Fibrinogen <1.5 g/L | 6.7 g/L | ||
| 5. Hemophagocytosis | Presence of phagocytosis | Presence | Yes |
| 6. Reduced natural killer cell activity | Natural killer cell activity is reduced or absent | 6% | No |
| 7. Elevated ferritin | Ferritin ≥500 μg/L | 1650 μg/L | Yes |
| 8. Elevated sCD25 | Soluble CD25 levels are elevated | 1820 U/mL | Yes |