{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T09:13:24Z","timestamp":1788513204123,"version":"build-2803163510"},"reference-count":48,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Haematology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Hemophagocytic lymphohistiocytosis (HLH) is a life\u2010threatening hyper\u2010inflammatory condition that can be triggered by viral infections. However, influenza is not commonly recognized as a cause of HLH, and there is no comprehensive synthesis of influenza\u2010associated HLH in the literature to guide clinicians. We conducted a systematic search of Pubmed and Embase to identify case reports and case series on influenza\u2010associated HLH, and included 29 articles involving 47 patients. Their age ranged from 2\u2009months to 72\u2009years. 67% were males. Influenza A accounted for 91.3% of the cases, predominantly H1N1 (90.2%). All patients had fever, 60% had anemia, 69.7% had thrombocytopenia, 46.6% had leukopenia, 61.3% had splenomegaly, 71.4% had hypertriglyceridemia, and 94.7% had elevated ferritin levels. 97.6% had hemophagocytosis on biopsy. Antiviral therapy was administered in 89.5% of patients. HLH\u2010directed therapy included corticosteroids (77%), intravenous immunoglobulin (36%), and etoposide (23.1%). Intensive care was required in 95.2% of cases. Overall survival was 53.2%. Survival rate was 50% among patients who received either antiviral therapy alone or HLH\u2010directed therapy alone, compared with 65.4% among those who received both. Further studies are necessary to establish standardized diagnostic and therapeutic protocols for influenza\u2010associated HLH.<\/jats:p>","DOI":"10.1111\/ejh.70241","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T09:42:52Z","timestamp":1781689372000},"page":"1044-1051","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Influenza as a Less Commonly Recognized Cause of Hemophagocytic Lymphohistiocytosis: A Systematic Review of Case Reports and Case Series"],"prefix":"10.1111","volume":"117","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0445-5515","authenticated-orcid":false,"given":"Kavya","family":"Balusu","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Rochester General Hospital  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Abdelhay","sequence":"additional","affiliation":[{"name":"Department of Hospital Medicine Washington University  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fnu","family":"Payal","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Rochester General Hospital  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kouides","sequence":"additional","affiliation":[{"name":"Department of Hematology Rochester General Hospital  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2314005"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(13)61048\u2010X"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.2147\/JBM.S46255"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2023.102143"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097\u20100142(197909)44:3<993::aid\u2010cncr2820440329>3.0.co;2\u20105"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/hematology.2025000707"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/rmv.638"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.26990"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643\u2010016\u20100384\u20104"},{"key":"e_1_2_8_11_1","unstructured":"JBI.Global \u201cJBI Critical Appraisal Checklist for Case Reports \u201d(2020) https:\/\/jbi.global\/critical\u2010appraisal\u2010tools."},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.11124\/JBISRIR-D-19-00099"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.4081\/hr.2019.8268"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.3109\/s10165-009-0241-6"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2005-1861"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.4103\/0972-5229.218137"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/1752-1947-5-280"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0b013e3181f46baf"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.4274\/Tjh.2013.0022"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1155\/2011\/951910"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2010.09-0666"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.45.1736"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pedneo.2013.03.006"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10156-011-0366-3"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/jbcr\/irab058"},{"issue":"1","key":"e_1_2_8_26_1","first-page":"77","article-title":"Successful Treatment of Seasonal Influenza A (H3N2) Infection\u2010Related Hemophagocytic Lymphocytosis in an Elderly Man, Kansenshogaku Zasshi","volume":"90","author":"Suzuki S.","year":"2016","journal-title":"Journal of the Japanese Association for Infectious Diseases"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-017-4839-4"},{"issue":"5","key":"e_1_2_8_28_1","first-page":"361","article-title":"A Case Report of H (7) N (9) Avian Influenza Complicated by Hemophagocytic Lymphohistiocytosis","volume":"57","author":"Yang W.","year":"2018","journal-title":"Zhonghua Nei Ke Za Zhi"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)61345-1"},{"issue":"6","key":"e_1_2_8_30_1","first-page":"784","article-title":"The Clinical Characteristics of Pediatric H1N1\u2010Associated Hemophagocytic Lymphohistiocytosis: A Case Report and Literature Review","volume":"45","author":"Su D. 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