{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T03:48:16Z","timestamp":1780112896360,"version":"3.54.0"},"reference-count":21,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,3,11]]},"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:p>Haemophagocytic lymphohistiocytosis (HLH) is a rare diagnosis that carries a high degree of mortality. We present this case of a previously healthy 22-year-old woman, who was admitted acutely ill to the hospital. One week prior, she had been seen by her primary care physician for fatigue and malaise. At that time, she was noted to have anterior and posterior cervical lymphadenopathy. She was referred to the emergency room and was diagnosed with acute Epstein-Barr virus (EBV) mononucleosis based on her clinical symptoms and positive heterophile antibody test. She was discharged after an uneventful 48-hour stay on the wards. She represented 7\u2009days after discharge with cough, fatigue, nausea, vomiting, epigastric abdominal pain, diarrhoea, weight loss and subjective fevers. She had also reported haematemesis, epistaxis and melaena. Vital signs included temperature 36.9\u00b0C, blood pressure 90\/50\u2009mm Hg, heart rate 130 beats per minute and respiratory rate 32 breaths per minute. Physical examination was notable for an acutely ill appearing woman with scleral icterus, hepatosplenomegaly and palpable cervical and axillary lymphadenopathy. Complete blood count showed pancytopaenia with haemoglobin 59\u2009g\/L (normal 120\u2013160\u2009g\/L), white blood cell count 2.7\u00d710<jats:sup>9<\/jats:sup>\/L (normal 4\u201310.5\u00d710<jats:sup>9<\/jats:sup>\/L) and platelet count 50\u00d710<jats:sup>9<\/jats:sup>\/L (normal 150\u2013450\u00d710<jats:sup>9<\/jats:sup>\/L). The white blood cell count differential included 58% neutrophils (normal 38%\u201377%) with immature neutrophils in band form elevated at 45% (normal &lt;14%), 16% lymphocytes (normal 20%\u201348%), 7% monocytes (normal &lt;12%) and no eosinophils (normal &lt;6%). Blood smear revealed anisocytosis, poikilocytosis and hypochromia. Coagulation panel showed elevated levels of d-dimer level at 1.39 \u00b5g\/mL (normal &lt;0.45 \u00b5g\/mL), prolonged prothrombin time at 34.4\u2009s (normal 11\u201315\u2009s), prolonged activated partial thromboplastin time of 55.6\u2009s (normal 25\u201334\u2009s), prolonged international normalised ratio at 3.31 (normal &lt;1.1) and low fibrinogen 60\u2009mg\/dL (normal &gt;200\u2009mg\/dL). Lipid panel showed cholesterol at 114\u2009mg\/dL (normal 125\u2013200\u2009mg\/dL), triglycerides 207\u2009mg\/dL (normal 30\u2013150\u2009mg\/dL), high-density lipoprotein cholesterol 10\u2009mg\/dL (normal 40\u201360\u2009mg\/dL) and low-density lipoprotein cholesterol 63\u2009mg\/dL (normal &lt;100\u2009mg\/dL). Other lab abnormalities included elevated ferritin of 6513\u2009ng\/mL (normal 10\u2013150\u2009ng\/mL) and elevated lactate dehydrogenase of 1071 unit\/L (normal 95\u2013240 unit\/L). Soluble interleukin-2 receptor alpha level was elevated at 60\u2009727 units\/mL (normal 223\u2013710 units\/mL). Fluorodeoxyglucose\u2013positron emission tomography (FDG-PET) scan showed abnormal tracer localisation within the paratracheal, hilar, pelvic, abdominal and subcarinal lymph nodes, along with FDG-PET positive hepatosplenomegaly. A bone marrow biopsy showed hypercellular marrow (95% cellularity) with trilineage haematopoiesis, haemophagocytic cells, polytypic plasmacytosis and T-cell lymphocytosis, along with positive latent membrane protein-1 immunohistochemical staining for EBV. EBV quantitative DNA PCR showed &gt;1\u2009million copies. These findings were consistent with a diagnosis of HLH secondary to EBV infection. Despite intense therapy with the HLH-94 protocol, the patient expired from her illness after a prolonged hospital course.<\/jats:p>","DOI":"10.1136\/bcr-2020-241222","type":"journal-article","created":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T12:27:35Z","timestamp":1617193655000},"page":"e241222","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Case of haemophagocytic lymphohistiocytosis following Epstein-Barr virus infection"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8427-6922","authenticated-orcid":false,"given":"Valeri","family":"Kraskovsky","sequence":"first","affiliation":[{"name":"Pulmonary, Critical Care and Sleep Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, 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