{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:10:13Z","timestamp":1756361413070,"version":"3.44.0"},"reference-count":29,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,7,15]]},"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:p>A male in his 30s who was recently diagnosed with HIV arrived at the emergency department exhibiting an altered mental state and acute respiratory distress. Initial laboratory tests revealed a high anion gap metabolic acidosis, elevated liver enzyme levels and bicytopenia. A CT scan identified a miliary pattern. Bronchoscopy with bronchoalveolar lavage displayed epithelial and inflammatory cells. However, subsequent tests ruled out the presence of fungi, Pneumocystis organisms, malignancies, granulomas and viral inclusions. Broad-spectrum antibiotics with emphasis on <jats:italic>Mycobacterium tuberculosis<\/jats:italic> and antifungal treatments were administered. The regimen was adjusted after a positive urine test for the Histoplasma antigen.<\/jats:p>\n               <jats:p>The patient later manifested signs and symptoms, including increased ferritin level, fever, splenomegaly, diminished natural killer cell function and heightened interleukin-2 receptor levels, confirming haemophagocytic lymphohistiocytosis. Given the patient\u2019s gravely decompensated state, the treatment incorporated dexamethasone, and the patient\u2019s vasopressor-resistant septic shock was addressed with methylene blue.<\/jats:p>","DOI":"10.1136\/bcr-2023-259484","type":"journal-article","created":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T12:00:18Z","timestamp":1724068818000},"page":"e259484","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Haemophagocytic lymphohistiocytosis (HLH) secondary to disseminated histoplasmosis infection in a patient with HIV"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9719-3509","authenticated-orcid":false,"given":"Joel Thomas","family":"Zimmerman","sequence":"first","affiliation":[{"name":"Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Courtney","family":"Hanson","sequence":"additional","affiliation":[{"name":"Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9645-9072","authenticated-orcid":false,"given":"Alfredo","family":"Iardino","sequence":"additional","affiliation":[{"name":"Critical Care, Pulmonology, CHI St Alexius Health Bismarck Medical Center, Bismarck, North Dakota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,8,19]]},"reference":[{"key":"2025082722275640000_17.8.e259484.1","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1146\/annurev-pathol-020117-043625","article-title":"Hemophagocytic Lymphohistiocytosis","volume":"13","author":"Al-Samkari","year":"2018","journal-title":"Annu Rev Pathol Mech Dis"},{"key":"2025082722275640000_17.8.e259484.2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2018894618"},{"key":"2025082722275640000_17.8.e259484.3","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1111\/ped.13064","article-title":"Hemophagocytic lymphohistiocytosis: Pathogenesis, diagnosis, and management","volume":"58","author":"Morimoto","year":"2016","journal-title":"Pediatr Int"},{"key":"2025082722275640000_17.8.e259484.4","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0b013e328306eb8d"},{"key":"2025082722275640000_17.8.e259484.5","unstructured":"Justiz Vaillant AA , Naik R . 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