{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:25:23Z","timestamp":1792686323026,"version":"4.5.0"},"reference-count":14,"publisher":"Georg Thieme Verlag KG","issue":"08","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dtsch Med Wochenschr"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>Ein 51-j\u00e4hriger Patient stellte sich mit Fieber, Dyspnoe und begleitenden Oberbauchschmerzen vor. Neben h\u00e4modynamischer Instabilit\u00e4t lagen ein generalisierter Ikterus, eine Hepatosplenomegalie, ein morbilliformes Exanthem mit Petechien sowie eine beidseitige Konjunktivitis vor.<\/jats:p><jats:p>Neben deutlich erh\u00f6hten Entz\u00fcndungsparametern fanden sich eine Panzytopenie und eine Hyperbilirubin\u00e4mie. Ferner waren Triglyzeride, Ferritin und der l\u00f6sliche IL-2-Rezeptor erh\u00f6ht. Es lie\u00dfen sich IgM-Antik\u00f6rper gegen Leptospiren im Blut nachweisen. In der Knochenmarkzytologie imponierte eine H\u00e4mophagozytose.<\/jats:p><jats:p>Es lie\u00df sich eine sekund\u00e4re h\u00e4mophagozytische Lymphohistiozytose auf dem Boden einer ikterischen Leptospirose (Weil-Krankheit) diagnostizieren.<\/jats:p><jats:p>Nach sofortiger antibiotischer Therapie und Kreislaufstabilisierung mittels Katecholaminen wurden weitere organunterst\u00fctzende Verfahren wie non-invasive Beatmung und H\u00e4modialyse etabliert. Nach fr\u00fchzeitiger Diagnosestellung wurde die Therapie mit hochdosierten Steroiden und Gabe von polyvalenten Immunglobulinen erg\u00e4nzt. Darunter kam es zur kontinuierlichen Besserung der Organfunktionen und zur vollst\u00e4ndigen Genesung.<\/jats:p><jats:p>Die h\u00e4mophagozytische Lymphohistiozytose ist eine wichtige Differenzialdiagnose der Sepsis. Sie kann aber auch durch diese getriggert sein. Die Sepsis kann ihrerseits durch seltene Erreger wie Leptospiren verursacht sein.<\/jats:p>","DOI":"10.1055\/a-2455-6902","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T22:46:11Z","timestamp":1743461171000},"page":"434-437","source":"Crossref","is-referenced-by-count":1,"title":["Sekund\u00e4re h\u00e4mophagozytische Lymphohistiozytose bei Leptospirose mit ikterischem Verlauf und Nierenversagen"],"prefix":"10.1055","volume":"150","author":[{"given":"Marvin","family":"Dumke","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Kardiologie und internistische Intensivmedizin, Johannes Wesling Klinikum Minden, Minden, Deutschland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Wilsdorf","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr H\u00e4matologie, Onkologie, H\u00e4mostaseologie und Palliativmedizin, Johannes Wesling Klinikum Minden, Minden, Deutschland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5315-0444","authenticated-orcid":false,"given":"Iris","family":"Barndt","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Kardiologie und internistische Intensivmedizin, Johannes Wesling Klinikum Minden, Minden, Deutschland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,3,31]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1002\/pbc.21039","article-title":"HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis","volume":"48","author":"JI Henter","year":"2007","journal-title":"Pediatr Blood Cancer"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/j.cytogfr.2014.10.001","article-title":"Hemophagocytic lymphohistiocytosis (HLH): A heterogeneous spectrum of cytokine-driven immune disorders","volume":"26","author":"E Brisse","year":"2015","journal-title":"Cytokine Growth Factor Rev"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1016\/j.annonc.2021.12.003","article-title":"Management of adults and children receiving CAR T-cell therapy: 2021 best practice recommendations of the European Society for Blood and Marrow Transplantation (EBMT) and the Joint Accreditation Committee of ISCT and EBMT (JACIE) and the European Haematology Association (EHA)","volume":"33","author":"PJ Hayden","year":"2022","journal-title":"Ann Oncol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1007\/s00432-020-03139-4","article-title":"Hemophagocytic lymphohistiocytosis in adults: collaborative analysis of 137 cases of a nationwide German registry","volume":"146","author":"S Birndt","year":"2020","journal-title":"J Cancer Res Clin Oncol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1186\/s13054-020-02941-3","article-title":"Hemophagocytic lymphohistiocytosis in critically ill patients: diagnostic reliability of HLH-2004 criteria and HScore","volume":"24","author":"C Knaak","year":"2020","journal-title":"Crit Care Lond Engl"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1097\/SHK.0000000000001048","article-title":"Hemophagocytic Lymphohistiocytosis: Potentially Underdiagnosed in Intensive Care Units","volume":"50","author":"G Lachmann","year":"2018","journal-title":"Shock Augusta Ga"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1097\/CCM.0000000000005361","article-title":"Consensus-Based Guidelines for the Recognition, Diagnosis, and Management of Hemophagocytic Lymphohistiocytosis in Critically Ill Children and Adults","volume":"50","author":"MR Hines","year":"2022","journal-title":"Crit Care Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.critrevonc.2017.03.023","article-title":"Similar but not the same: Differential diagnosis of HLH and sepsis","volume":"114","author":"R Machowicz","year":"2017","journal-title":"Crit Rev Oncol Hematol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1793","DOI":"10.1097\/00003246-199811000-00016","article-title":"Use of the SOFA score to assess the incidence of organ dysfunction\/failure in intensive care units: results of a multicenter, prospective study. 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