{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T14:45:45Z","timestamp":1787582745012,"version":"build-2736575974"},"reference-count":14,"publisher":"Grigore T. Popa University of Medicine and Pharmacy","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Clin Cases"],"abstract":"<jats:p>Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome caused by dysregulated immune activation. Viral infections, particularly Epstein\u2013Barr virus, are well-known triggers; however, HLH associated with acute viral hepatitis is rare, especially in the setting of hepatitis A (HAV) and hepatitis E (HEV) coinfection. A 30-year-old male presented with fever following the onset of jaundice, along with fatigue and dyspnea. Laboratory evaluation revealed severe hyperbilirubinemia, markedly elevated transaminases, anemia, hyperferritinemia, and hypertriglyceridemia. He also had hemolysis due to glucose 6 phosphate dehydrogenase (G6PD) deficiency. Bone marrow examination demonstrated hemophagocytosis. Viral markers confirmed HAV and HEV coinfection. Although he fulfilled five out of eight HLH-2004 criteria, sepsis markers like raised procalcitonin and leukocytosis posed diagnostic challenge. He was managed with supportive care alone, and showed spontaneous clinical and biochemical improvement without immunosuppressive therapy. This case highlights a probable HLH spectrum disorder triggered by HAV\u2013HEV coinfection. It underscores the importance of considering HLH in patients with acute viral hepatitis who develop persistent fever and cytopenia, while also recognizing that selected patients may improve with supportive care alone.<\/jats:p>","DOI":"10.22551\/2026.51.1302.10340","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T14:08:36Z","timestamp":1787580516000},"page":"43-46","source":"Crossref","is-referenced-by-count":0,"title":["Secondary hemophagocytic lymphohistiocytosis mimicking sepsis in hepatitis A\u2013E coinfection: spontaneous recovery with supportive care"],"prefix":"10.22551","volume":"13","author":[{"name":"Department of Gastroenterology, The Mission Hospital, Durgapur, West Bengal, India","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gourab","family":"Bhaduri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2693-1298","authenticated-orcid":false,"given":"Mekhala","family":"Paul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Critical Care, The Mission Hospital, Durgapur, West Bengal, India","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3562-6652","authenticated-orcid":false,"given":"Bijan","family":"Basak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Pathology, The Mission Hospital, Durgapur, West Bengal, India","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"9837","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"\"1. Termsinsuk P, Sirisanthiti P. Acute hepatitis A infection-associated hemophagocytic lymphohistiocytosis in adult presenting as impending acute liver failure: A case report and literature review. Clin Case Rep. 2022 Feb 7;10(2):e05334. doi: 10.1002\/ccr3.5334. PMID: 35154712; PMCID: PMC8819581.","DOI":"10.1002\/ccr3.5334"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"2. Gupta S, Weitzman S. Primary and secondary hemophagocytic lymphohistiocytosis: clinical features, pathogenesis and therapy. Expert Rev Clin Immunol. 2010 Jan;6(1):137-54. doi: 10.1586\/eci.09.58. PMID: 20383897.","DOI":"10.1586\/eci.09.58"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"3. Jordan MB, Allen CE, Weitzman S, et al. How I treat hemophagocytic lymphohistiocytosis. Blood. 2011 Oct 13;118(15):4041-52. doi: 10.1182\/blood-2011-03-278127. Epub 2011 Aug 9. 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Intern Med. 2002;41(12):1188-92. doi:10.2169\/internalmedicine.41.1188 PubMed PMID: 12521213.","DOI":"10.2169\/internalmedicine.41.1188"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"13. Desai N, Vetal D, Kulkarni A, et al. Hemophagocytic lymphohistiocytosis: a rare complication of acute hepatitis E infection. J Assoc Physicians India. 2024;72(4):91-3. doi: 10.59556\/japi.72.0499. PMID: 38881088.","DOI":"10.59556\/japi.72.0499"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"14. Uemura M, Huynh R, Kuo A, et al. Hemophagocytic Lymphohistiocytosis Complicating T-Cell Lymphoma in a Patient with HIV Infection. Case Rep Hematol. 2013;2013:687260. doi: 10.1155\/2013\/687260. 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