{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T12:03:41Z","timestamp":1777637021057,"version":"3.51.4"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012556","name":"Sichuan Provincial Youth Science and Technology Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012556","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Hemophagocytic lymphohistiocytosis (HLH) is a fatal hyperinflammatory complication of scrub typhus, often with delayed diagnosis. This case report aims to detail the clinical trajectory and successful management of scrub typhus-associated HLH in a child, highlighting key diagnostic clues.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A previously healthy 14-year-old boy from a scrub typhus-endemic area presented with prolonged high fever, cough, and lethargy. Physical examination revealed a pathognomonic eschar.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Laboratory findings fulfilled HLH-2004 diagnostic criteria, including cytopenias, hyperferritinemia (&amp;gt;3,000\u2005ng\/mL), hypofibrinogenemia, and hemophagocytosis on bone marrow aspirate. The patient was diagnosed with secondary HLH triggered by scrub typhus. Immediate treatment with oral doxycycline, combined with immunomodulation using intravenous immunoglobulin and dexamethasone, led to fever resolution within 72\u2005h and full recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights that in pediatric scrub typhus, a rapid decline in platelets\/fibrinogen and a sharp rise in ferritin\/LDH should alert clinicians to possible HLH. Early combined therapy targeting both the infection (e.g., doxycycline) and the cytokine storm (e.g., immunomodulators) may be beneficial for favorable outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1787726","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T06:00:20Z","timestamp":1777442420000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Successful management of scrub typhus-associated hemophagocytic lymphohistiocytosis with doxycycline and immunomodulation: a case report"],"prefix":"10.3389","volume":"14","author":[{"given":"Yuanyuan","family":"Hua","sequence":"first","affiliation":[{"name":"Department of Pediatrics, the First People\u2019s Hospital, Liangshan Yi Autonomous Prefecture","place":["Sichuan, China"]},{"name":"Department of Intensive Care Unit, Children\u2019s Hospital of Chongqing Medical University, National Clinical Research Center for Children and Adolescents\u2019 Health and Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Jin Yang County People\u2019s Hospital, Liangshan Yi Autonomous Prefecture","place":["Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jimin","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, the First People\u2019s Hospital, Liangshan Yi Autonomous Prefecture","place":["Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, the First People\u2019s Hospital, Liangshan Yi Autonomous Prefecture","place":["Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feng","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit, Children\u2019s Hospital of Chongqing Medical University, National Clinical Research Center for Children and Adolescents\u2019 Health and Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.jare.2018.05.007","article-title":"Clinical characteristics and effective treatments of scrub typhus-associated hemophagocytic lymphohistiocytosis in children","volume":"15","author":"Jin","year":"2018","journal-title":"J Adv 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