{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T14:13:02Z","timestamp":1764943982069,"version":"3.46.0"},"reference-count":8,"publisher":"SMC Media","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Fever, rash, and shock in adults pose diagnostic and therapeutic challenges. Markedly elevated ferritin often raises suspicion for hemophagocytic lymphohistiocytosis (HLH), yet hyperferritinaemia is also encountered in sepsis, adult-onset Still\u2019s disease (AOSD), and viral infections. Case report:\u00a0We describe the case of a 27-year-old woman who developed a high fever, diffuse erythematous rash, hypotension, and markedly elevated ferritin levels. The initial differential diagnoses included toxic shock syndrome, HLH, AOSD, and viral exanthema. Extensive evaluations for infectious, autoimmune, and malignant diseases were negative. Imaging demonstrated gallstones with gallbladder wall inflammation, which was likely the trigger for the systemic inflammatory response. With supportive care and early multidisciplinary input, the patient made a full recovery without the need for immunosuppressive therapy. Conclusion:\u00a0This case highlights the importance of contextualising ferritin elevation and maintaining a broad differential diagnosis. Serial laboratory trends, careful use of HLH scoring systems, and multidisciplinary collaboration prevented premature immunosuppression and ensured a favourable outcome.<\/jats:p>","DOI":"10.12890\/2025_005887","type":"journal-article","created":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T08:59:47Z","timestamp":1762246787000},"source":"Crossref","is-referenced-by-count":0,"title":["Febrile rash, shock, and hyperferritinaemia in a young woman: navigating the diagnostic overlap of hemophagocytic lymphohistiocytosis, toxic shock, and viral exanthema"],"prefix":"10.12890","volume":"12","author":[{"given":"Pavankumar","family":"Hulikere Srinivasaiah","sequence":"first","affiliation":[{"name":"Emergency Medicine, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; Emergency Medicine, Severn PGME School of Emergency Medicine, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kasi","family":"Vishwanath Surabhi","sequence":"first","affiliation":[{"name":"Acute Medicine, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2025,11,4]]},"reference":[{"key":"10.12890\/2025_005887_ref1","doi-asserted-by":"crossref","unstructured":"Allen CE, Yu X, Kozinetz CA, McClain KL. Highly elevated ferritin levels and the diagnosis of hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 2008;50:1227\u20131235. doi: 10.1002\/pbc.21423","DOI":"10.1002\/pbc.21423"},{"key":"10.12890\/2025_005887_ref2","doi-asserted-by":"crossref","unstructured":"Jordan MB, Allen CE, Weitzman S, Filipovich AH, McClain KL. Challenges in the diagnosis of hemophagocytic lymphohistiocytosis: recommendations from the North American Consortium for Histiocytosis. Pediatr Blood Cancer 2019;66:e27929. doi: 10.1002\/pbc.27929","DOI":"10.1002\/pbc.27929"},{"key":"10.12890\/2025_005887_ref3","doi-asserted-by":"crossref","unstructured":"Schuster FS, Nyvlt P, Heeren P, Spies C, Moritz FA, Schenk T. Differential diagnosis of hyperferritinemia in critically ill adult patients. J Clin Med 2022;12:192. doi: 10.3390\/jcm12010192","DOI":"10.3390\/jcm12010192"},{"key":"10.12890\/2025_005887_ref4","doi-asserted-by":"crossref","unstructured":"Vassilopoulos A, McCormick W, Lakhani A. Update in hyperferritinemic syndromes: recognition and management\u2014a scoping review. Br J Haematol 2022;198:1030\u20131042. doi: 10.56305\/001c.37667","DOI":"10.56305\/001c.37667"},{"key":"10.12890\/2025_005887_ref5","doi-asserted-by":"crossref","unstructured":"Atchade E, De Tymowski C, Grall N, Tanaka S, Montravers P. Toxic shock syndrome: a literature review. Antibiotics (Basel) 2024;13:96. doi: 10.3390\/antibiotics13010096","DOI":"10.3390\/antibiotics13010096"},{"key":"10.12890\/2025_005887_ref6","doi-asserted-by":"crossref","unstructured":"Gerfaud-Valentin M, Jamilloux Y, Iwaz J, S\u00e8ve P. Adult-onset Still\u2019s disease. Autoimmun Rev 2014;13:708\u2013722. doi: 10.1016\/j.autrev.2014.01.058","DOI":"10.1016\/j.autrev.2014.01.058"},{"key":"10.12890\/2025_005887_ref7","doi-asserted-by":"crossref","unstructured":"Long T, Xu J, Lin BZ, Li SG. Early identification of macrophage activation syndrome in adult-onset Still\u2019s disease: a case report and literature review. Front Med 2025;12:1498928. doi: 10.3389\/fmed.2025.1498928","DOI":"10.3389\/fmed.2025.1498928"},{"key":"10.12890\/2025_005887_ref8","doi-asserted-by":"crossref","unstructured":"Fardet L, Galicier L, Lambotte O, Marzac C, Aumont C, Chahwan D, et al. Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome. Arthritis Rheumatol 2014;66:2613-2620. doi: 10.1002\/art.38690","DOI":"10.1002\/art.38690"}],"container-title":["European Journal of Case Reports in Internal Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/5887\/4953","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/5887\/4954","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/5887\/4954","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T14:09:35Z","timestamp":1764943775000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/view\/5887"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,4]]},"references-count":8,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.12890\/2025_005887","relation":{"has-manifestation":[{"id-type":"other","id":"1-132-5887-g4953","asserted-by":"subject"},{"id-type":"other","id":"1-132-5887-g4954","asserted-by":"subject"}],"is-part-of":[{"id-type":"other","id":"1-132","asserted-by":"subject"}]},"ISSN":["2284-2594"],"issn-type":[{"type":"electronic","value":"2284-2594"}],"subject":[],"published":{"date-parts":[[2025,11,4]]}}}