{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T20:05:01Z","timestamp":1772568301364,"version":"3.50.1"},"reference-count":11,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T00:00:00Z","timestamp":1713830400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"Abstract* The accidental, suicidal, and homicidal toxicities of copper sulfate have been extensively documented. The later stages of the disease demonstrate signs of systemic toxicity, characterized by intravascular hemolysis, oliguric renal failure, convulsions, and circulatory collapse. Despite the extensive description of life-threatening intravascular hemolysis, Hemophagocytic Lymphohistiocytosis (HLH) related to copper sulfate poisoning has not been described. A 45-year-old male presented with accidental consumption of copper sulfate. Laboratory evaluation revealed leukocytosis, intravascular hemolysis, acute liver injury, acute kidney injury, severe metabolic acidosis, and hyperkalemia. The patient was shifted to the Intensive Care Unit and hemodialysis was initiated. On the 9th day, he developed high-grade fever with chills. With the suspicion of a central line-associated bloodstream infection, empirical antibiotic therapy was initiated, and the lines were revised. On the 19th day, the high-grade fever recurred. Investigations revealed trilineage cytopenias. With a high degree of suspicion for HLH, further investigations revealed increased ferritin levels. Bone marrow aspiration cytology showed evidence of reactive marrow with haemophagocytic lymphohistiocytosis. The patient was initiated on corticosteroid therapy, after which symptomatic and laboratory recovery was noted. Although copper sulfate poisoning is potentially fatal in large quantities, few studies have examined the possible immune-mediated abnormalities in individuals. Owing to the direct membranolytic effect of copper sulfate, it is not unreasonable to have immune-mediated organ damage. To the best of our knowledge, this is the first report of Hemophagocytic Lymphohistiocytosis attributed to copper sulfate intoxication. The present case demonstrates that the diagnosis of HLH must be considered when treating a case of copper sulfate poisoning; however, the exclusion of the most common complications must be first established.<\/ns7:p>","DOI":"10.12688\/f1000research.147189.1","type":"journal-article","created":{"date-parts":[[2024,6,20]],"date-time":"2024-06-20T04:20:09Z","timestamp":1718857209000},"page":"326","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Copper sulphate related hemophagocytosis with lymphohistiocytosis"],"prefix":"10.12688","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4483-2725","authenticated-orcid":false,"given":"Koushik","family":"Ramachandra","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7224-2996","authenticated-orcid":false,"given":"Amruth","family":"Reddy Narayana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1258-5208","authenticated-orcid":false,"given":"Samyuktha","family":"Srinivas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5325-7086","authenticated-orcid":false,"given":"Sridevi","family":"H B","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2024,4,23]]},"reference":[{"key":"ref3","doi-asserted-by":"publisher","first-page":"31-35","DOI":"10.2478\/10004-1254-59-2008-1847","article-title":"Severe acute copper sulphate poisoning: a case report.","volume":"59","author":"A Sinkovic","year":"2008 Mar","journal-title":"Arh. 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Blood Cancer."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"775-781","DOI":"10.2169\/internalmedicine.48.1677","article-title":"Analysis of triglyceride value in the diagnosis and treatment response of secondary hemophagocytic syndrome.","volume":"48","author":"M Okamoto","year":"2009","journal-title":"Intern. Med."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1686-1691","DOI":"10.1093\/rheumatology\/ken342","article-title":"Clinical features of haemophagocytic syndrome in patients with systemic autoimmune diseases: analysis of 30 cases.","volume":"47","author":"S Fukaya","year":"2008 Nov","journal-title":"Rheumatology (Oxford)."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1177\/039139888901201002","article-title":"Copper sulphate poisoning and acute renal failure.","volume":"12","author":"S Dash","year":"1989 Oct","journal-title":"Int. J. Artif. Organs."},{"key":"ref14","first-page":"1240-1242","article-title":"Copper sulphate poisoning and exchange transfusion.","volume":"22","author":"M Malik","year":"2011 Nov","journal-title":"Saudi J. Kidney Dis. Transpl."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/13-326\/v1\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/13-326\/v1\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/13-326\/v1\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T19:29:14Z","timestamp":1772566154000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/13-326\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,23]]},"references-count":11,"URL":"https:\/\/doi.org\/10.12688\/f1000research.147189.1","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.161355.r328792","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.161355.r288685","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.161355.r288685","asserted-by":"object"},{"id-type":"doi","id":"10.5256\/f1000research.161355.r328792","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,23]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/13-326\/v1#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.161355.r288685, Nur Soyer, Ege University, Izmir, 20 Jun 2024, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/13-326\/v1#referee-response-288685","order":0,"name":"referee-response-288685","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Koushik Ramachandra<\/b>; \nPosted: 20 Jun 2024<\/i>; Thank you for reviewing our case report Dr. Nur Soyer.","URL":"https:\/\/f1000research.com\/articles\/13-326\/v1#referee-comment-11832","order":1,"name":"referee-comment-11832","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.161355.r328792, Ajith Kumar, Aster Whitefield Hospital,, Bengaluru, Karnataka, 17 Oct 2024, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/13-326\/v1#referee-response-328792","order":2,"name":"referee-response-328792","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Koushik Ramachandra<\/b>; \nPosted: 17 Oct 2024<\/i>; We thank you for reviewing our report Sir. As you have pointed out interactions between ethanol and copper sulphate could have set off an immune response. Though chemically, ethanol is known to precipitate copper sulphate into a salt, we are uncertain as to how their interactions behave invivo and how they affect human tissues. H Score calculations: Prior to Bone Marrow studies- 200 points HScore; 80-88% Probability of hemophagocytic syndrome INPUTS: Known underlying immunosuppression \u2014> 0 = No, Temperature, °F (°C) \u2014> 49 = >102.9 (>39.4), Organomegaly \u2014> 38 = Hepatomegaly and splenomegaly, Number of cytopenias \u2014> 34 = 3 lineages, Ferritin, ng\/mL (or \u03bcg\/L) \u2014> 35 = 2,000\u20136,000 [3343], Triglycerides, mg\/dL (mmol\/L) \u2014> 44 = 132.7-354 [250], Fibrinogen, mg\/dL (g\/L) \u2014> 0 = >250 [300], AST, U\/L \u2014> 0 = <30 [13], Hemophagocytosis features on bone marrow aspirate \u2014> 0 = No After Bone Marrow studies- 235 points HScore; 98-99% Probability of hemophagocytic syndrome INPUTS: Known underlying immunosuppression \u2014> 0 = No, Temperature, °F (°C) \u2014> 49 = >102.9 (>39.4), Organomegaly \u2014> 38 = Hepatomegaly and splenomegaly, Number of cytopenias \u2014> 34 = 3 lineages, Ferritin, ng\/mL (or \u03bcg\/L) \u2014> 35 = 2,000\u20136,000 [3343], Triglycerides, mg\/dL (mmol\/L) \u2014> 44 = 132.7-354 [250], Fibrinogen, mg\/dL (g\/L) \u2014> 0 = >250 [300], AST, U\/L \u2014> 0 = <30 [13], Hemophagocytosis features on bone marrow aspirate \u2014> 35 = Yes As mentioned in your comment, there was good agreement between the score and diagnosis of secondary HLH.","URL":"https:\/\/f1000research.com\/articles\/13-326\/v1#referee-comment-12662","order":3,"name":"referee-comment-12662","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}