Disseminated histoplasmosis induced hemophagocytic lymphohistiocytosis in an immunocompromised patient
Background: The search for the trigger of hemophagocytic lymphohistiocytosis (HLH) and its management can be challenging in immunocompromised patients. In HLH triggered by infection, immunosuppressive therapy is desired to suppress hyperinflammation, but may worsen the underlying infection. Objectiv...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-04-01
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| Series: | Clinical Infection in Practice |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590170225000810 |
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| author | N.El Bardai L.M. Vos H.L. Leavis M. Jak A.H.W. Bruns M. Limper |
| author_facet | N.El Bardai L.M. Vos H.L. Leavis M. Jak A.H.W. Bruns M. Limper |
| author_sort | N.El Bardai |
| collection | DOAJ |
| description | Background: The search for the trigger of hemophagocytic lymphohistiocytosis (HLH) and its management can be challenging in immunocompromised patients. In HLH triggered by infection, immunosuppressive therapy is desired to suppress hyperinflammation, but may worsen the underlying infection. Objectives: To review available literature on the management and prognosis of immunocompromised patients with disseminated histoplasmosis induced HLH. Methods: We describe a case and review all previously reported cases of disseminated histoplasmosis induced HLH on PubMed until June 2023. Results: The literature review yielded 30 cases. Antifungal therapy was administered in all except one patient. In 18 cases, HLH was treated with immunosuppressive therapy. The most common immunosuppressive regimens were corticosteroid monotherapy and corticosteroids combined with etoposide. This case report is the first to describe the use of anakinra. The overall mortality rate was 23.3 % (n = 7). Conclusions: Disseminated histoplasmosis induced HLH is a severe disorder, requiring prompt recognition and immediate intervention. Currently, no specific treatment protocol exists for this disorder. Treatment should be tailored to the patient’s condition, symptoms and individual characteristics. Careful consideration regarding immunosuppressive therapy for HLH is needed to prevent worsening of the infection. Additionally, anticipating the progression of the disease is necessary to ensure timely and appropriate interventions. |
| format | Article |
| id | doaj-art-57a0ff8c969141eaa208c2ef07bc7809 |
| institution | DOAJ |
| issn | 2590-1702 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical Infection in Practice |
| spelling | doaj-art-57a0ff8c969141eaa208c2ef07bc78092025-08-20T03:21:55ZengElsevierClinical Infection in Practice2590-17022025-04-012610048810.1016/j.clinpr.2025.100488Disseminated histoplasmosis induced hemophagocytic lymphohistiocytosis in an immunocompromised patientN.El Bardai0L.M. Vos1H.L. Leavis2M. Jak3A.H.W. Bruns4M. Limper5University Medical Centre Utrecht, Department of Rheumatology and Clinical Immunology, Utrecht, Netherlands; Corresponding author at: Heidelberglaan 100, 3584 CX Utrecht, Netherlands.University Medical Centre Utrecht, Department of Internal Medicine and Infectiology, Utrecht, NetherlandsUniversity Medical Centre Utrecht, Department of Rheumatology and Clinical Immunology, Utrecht, NetherlandsUniversity Medical Centre Utrecht, Department of Internal Medicine and Haematology, Utrecht, NetherlandsUniversity Medical Centre Utrecht, Department of Internal Medicine and Infectiology, Utrecht, NetherlandsUniversity Medical Centre Utrecht, Department of Rheumatology and Clinical Immunology, Utrecht, NetherlandsBackground: The search for the trigger of hemophagocytic lymphohistiocytosis (HLH) and its management can be challenging in immunocompromised patients. In HLH triggered by infection, immunosuppressive therapy is desired to suppress hyperinflammation, but may worsen the underlying infection. Objectives: To review available literature on the management and prognosis of immunocompromised patients with disseminated histoplasmosis induced HLH. Methods: We describe a case and review all previously reported cases of disseminated histoplasmosis induced HLH on PubMed until June 2023. Results: The literature review yielded 30 cases. Antifungal therapy was administered in all except one patient. In 18 cases, HLH was treated with immunosuppressive therapy. The most common immunosuppressive regimens were corticosteroid monotherapy and corticosteroids combined with etoposide. This case report is the first to describe the use of anakinra. The overall mortality rate was 23.3 % (n = 7). Conclusions: Disseminated histoplasmosis induced HLH is a severe disorder, requiring prompt recognition and immediate intervention. Currently, no specific treatment protocol exists for this disorder. Treatment should be tailored to the patient’s condition, symptoms and individual characteristics. Careful consideration regarding immunosuppressive therapy for HLH is needed to prevent worsening of the infection. Additionally, anticipating the progression of the disease is necessary to ensure timely and appropriate interventions.http://www.sciencedirect.com/science/article/pii/S2590170225000810 |
| spellingShingle | N.El Bardai L.M. Vos H.L. Leavis M. Jak A.H.W. Bruns M. Limper Disseminated histoplasmosis induced hemophagocytic lymphohistiocytosis in an immunocompromised patient Clinical Infection in Practice |
| title | Disseminated histoplasmosis induced hemophagocytic lymphohistiocytosis in an immunocompromised patient |
| title_full | Disseminated histoplasmosis induced hemophagocytic lymphohistiocytosis in an immunocompromised patient |
| title_fullStr | Disseminated histoplasmosis induced hemophagocytic lymphohistiocytosis in an immunocompromised patient |
| title_full_unstemmed | Disseminated histoplasmosis induced hemophagocytic lymphohistiocytosis in an immunocompromised patient |
| title_short | Disseminated histoplasmosis induced hemophagocytic lymphohistiocytosis in an immunocompromised patient |
| title_sort | disseminated histoplasmosis induced hemophagocytic lymphohistiocytosis in an immunocompromised patient |
| url | http://www.sciencedirect.com/science/article/pii/S2590170225000810 |
| work_keys_str_mv | AT nelbardai disseminatedhistoplasmosisinducedhemophagocyticlymphohistiocytosisinanimmunocompromisedpatient AT lmvos disseminatedhistoplasmosisinducedhemophagocyticlymphohistiocytosisinanimmunocompromisedpatient AT hlleavis disseminatedhistoplasmosisinducedhemophagocyticlymphohistiocytosisinanimmunocompromisedpatient AT mjak disseminatedhistoplasmosisinducedhemophagocyticlymphohistiocytosisinanimmunocompromisedpatient AT ahwbruns disseminatedhistoplasmosisinducedhemophagocyticlymphohistiocytosisinanimmunocompromisedpatient AT mlimper disseminatedhistoplasmosisinducedhemophagocyticlymphohistiocytosisinanimmunocompromisedpatient |