{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T10:08:15Z","timestamp":1764842895105,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,5,19]]},"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:p>Haemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening disorder caused by uncontrolled activation of the immune system, leading to phagocytosis of blood cells and cytokine storm. HLH can manifest in childhood due to a genetic mutation, but in adults HLH arises secondary to viral infections, autoimmune diseases or neoplastic processes. The most common viral infections associated with HLH are Epstein-Barr virus (EBV) and cytomegalovirus (CMV). EBV and CMV coinfection associated with HLH, however, is exceedingly rare. We present a case of HLH secondary to EBV and CMV coinfection in a young adult who presented with recurrent intermittent high-grade fevers and epistaxis. This case illustrates the importance of considering HLH in patients with idiopathic fevers and to consider all the potential aetiologies for HLH to ensure proper treatment.<\/jats:p>","DOI":"10.1136\/bcr-2023-258219","type":"journal-article","created":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T22:35:11Z","timestamp":1716935711000},"page":"e258219","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Haemophagocytic lymphohistiocytosis secondary to Epstein-Barr and cytomegalovirus coinfection"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0702-7209","authenticated-orcid":false,"given":"Ali Zagham","family":"Nasir","sequence":"first","affiliation":[{"name":"Internal Medicine Residency, Trinity Health West Michigan Library Services, Grand Rapids, Michigan, 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