A Case of Secondary Hemophagocytic Lymphohistiocytosis in a Patient With Acute HIV Infection

A 22-year-old man who has sex with men with no significant medical history presented with a 2-week history of fever and right upper abdominal pain. Initial blood tests revealed leukopenia, thrombocytopenia, and elevated liver enzymes. The diagnosis of secondary hemophagocytic lymphohistiocytosis (HL...

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Bibliographic Details
Main Authors: Yiliam Castillo, Liorge Dominguez, Antonio Crespo, Julio J. Alvarez Cardona
Format: Article
Language:English
Published: American College of Physicians 2025-06-01
Series:Annals of Internal Medicine: Clinical Cases
Online Access:https://www.acpjournals.org/doi/10.7326/aimcc.2025.0034
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Summary:A 22-year-old man who has sex with men with no significant medical history presented with a 2-week history of fever and right upper abdominal pain. Initial blood tests revealed leukopenia, thrombocytopenia, and elevated liver enzymes. The diagnosis of secondary hemophagocytic lymphohistiocytosis (HLH) was supported by fever, splenomegaly, hypertriglyceridemia, hyperferritinemia, and high soluble interleukin-2 receptors, meeting the 5/8 criteria of the Histiocyte Society-2004. Further laboratory tests indicated an elevated HIV RNA viral load, supporting a diagnosis of acute HIV infection. Our case suggests that identifying acute HIV infection as a trigger for secondary HLH is crucial for enabling prompt initiation of therapy, potentially preventing fatal outcomes.
ISSN:2767-7664