{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T07:22:45Z","timestamp":1792135365913,"version":"4.4.0"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:00:00Z","timestamp":1764806400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:00:00Z","timestamp":1764806400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009367","name":"Mansoura University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009367","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Nephrol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Hemophagocytic lymphohistiocytosis is a rare, severe, and potentially fatal disease, mainly encountered in individuals with immunologic diseases. Early diagnosis and prompt intervention may be life-saving. Herein, we report a case of a 52-year-old man who had undergone kidney transplantation nine years previously, presenting with persistent fever of unknown origin and graft function impairment. Despite receiving broad-spectrum antimicrobials and undergoing an exhaustive work-up for infectious, autoimmune, and oncologic diseases, he developed pancytopenia, hepatosplenomegaly, and respiratory failure. A bone marrow biopsy revealed florid hemophagocytosis, hyperferritinemia, hypertriglyceridemia, elevated serum soluble CD25, and cytopenia. These findings fulfilled seven of the Hemophagocytic lymphohistiocytosis 2004 criteria. High dose dexamethasone induced a partial, transitory response and lowered the fever, but multiorgan failure progressed, and the patient died three weeks after ICU admission. This case underscores that hemophagocytic lymphohistiocytosis should be considered whenever kidney transplant recipients develop unexplained fever, cytopenia, and hyperferritinemia, and suggests that early bone marrow evaluation with targeted immunomodulation may improve outcomes in this vulnerable population.<\/jats:p>\n                  <jats:p>\n                    <jats:bold>Graphical Abstract<\/jats:bold>\n                  <\/jats:p>","DOI":"10.1007\/s40620-025-02446-8","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T16:06:44Z","timestamp":1764864404000},"page":"3005-3011","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Hemophagocytic lymphohistiocytosis in kidney transplantation: a call for heightened vigilance"],"prefix":"10.1093","volume":"38","author":[{"given":"Ahmed Mansour","family":"Abdel-Rahman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8735-9416","authenticated-orcid":false,"given":"Muhammed Ahmed","family":"Elhadedy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donia Elsaed","family":"Gad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Elsherbini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayman F.","family":"Refaie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"issue":"6","key":"2446_CR1","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1016\/j.blre.2016.05.001","volume":"30","author":"A Hayden","year":"2016","unstructured":"Hayden A, Park S, Giustini D, Lee AY, Chen LY (2016) Hemophagocytic syndromes (HPSs) including hemophagocytic lymphohistiocytosis (HLH) in adults: a systematic scoping review. Blood Rev 30(6):411\u2013420. https:\/\/doi.org\/10.1016\/j.blre.2016.05.001","journal-title":"Blood Rev"},{"issue":"6","key":"2446_CR2","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1007\/s00277-011-1380-3","volume":"91","author":"HS Park","year":"2012","unstructured":"Park HS, Kim DY, Lee JH, Lee JH, Kim SD, Park YH, Lee JS, Kim BY, Jeon M, Kang YA, Lee YS, Seol M, Lee YJ, Lim YS, Jang S, Park CJ, Chi HS, Lee KH (2012) Clinical features of adult patients with secondary hemophagocytic lymphohistiocytosis from causes other than lymphoma: an analysis of treatment outcome and prognostic factors. Ann Hematol 91(6):897\u2013904. https:\/\/doi.org\/10.1007\/s00277-011-1380-3","journal-title":"Ann Hematol"},{"issue":"2","key":"2446_CR3","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1097\/01.tp.0000107285.86939.37","volume":"77","author":"A Karras","year":"2004","unstructured":"Karras A, Thervet E, Legendre C (2004) Hemophagocytic syndrome in renal transplant recipients: report of 17 cases and review of literature. Transplantation 77(2):238\u2013243. https:\/\/doi.org\/10.1097\/01.tp.0000107285.86939.37","journal-title":"Transplantation"},{"issue":"5","key":"2446_CR4","doi-asserted-by":"publisher","first-page":"1566","DOI":"10.1016\/j.transproceed.2020.02.047","volume":"52","author":"G Mascia","year":"2020","unstructured":"Mascia G, Argiolas D, Carta E, Ibba S, Piredda GB (2020) Hemophagocytic lymphohistiocytosis in renal transplant recipients: a 2-case report. Transplant Proc 52(5):1566\u20131569. https:\/\/doi.org\/10.1016\/j.transproceed.2020.02.047","journal-title":"Transplant Proc"},{"key":"2446_CR5","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1146\/annurev-pathol-020117-043625","volume":"13","author":"H Al-Samkari","year":"2018","unstructured":"Al-Samkari H, Berliner N (2018) Hemophagocytic Lymphohistiocytosis. Annu Rev Pathol 13:27\u201349. https:\/\/doi.org\/10.1146\/annurev-pathol-020117-043625","journal-title":"Annu Rev Pathol"},{"issue":"2","key":"2446_CR6","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1002\/pbc.21039","volume":"48","author":"JI Henter","year":"2007","unstructured":"Henter JI, Horne A, Aric\u00f3 M, Egeler RM, Filipovich AH, Imashuku S, Ladisch S, McClain K, Webb D, Winiarski J, Janka G (2007) HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. 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This case report was prepared in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"All procedures performed in this case report were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human and animal rights"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"This case report describes a retrospective analysis of routine clinical care. The patient provided standard informed consent for all diagnostic and therapeutic procedures during his clinical care at the Urology and Nephrology Center, Mansoura University.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Written informed consent for publication of this case report and accompanying images was obtained from the patient's next of kin following his death. A copy of the written consent is available for review by the Editor-in-Chief of this journal upon request.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}}]}}