Fogelson Benjamin, Patel Krupa, Spoons Jared, Stephens Shawna, Edwards Megan
Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
IDCases. 2022 Aug 22;29:e01612. doi: 10.1016/j.idcr.2022.e01612. eCollection 2022.
A 30-year-old Honduran male with recently diagnosed AIDS presented with a 1-month history of worsening abdominal pain, diarrhea, and fever. Initial investigations were notable for Cytomegalovirus viremia and diffuse lymphadenopathy. Axillary lymph node biopsy demonstrated necrotizing lymphadenitis with disseminated histoplasmosis. Despite aggressive antimicrobial therapy he continued to clinically deteriorate raising suspicion for hemophagocytic lymphohistiocytosis. The patient met 5 of 8 HLH-2004 diagnostic criteria and was successfully treated with dexamethasone and etoposide per the HLH-94 protocol. Despite the high mortality rates and poor clinical outcomes of hemophagocytic lymphohistiocytosis in patients living with HIV/AIDS, this case demonstrates that this high-risk patient population can be successfully treated and survive acquired hemophagocytic lymphohistiocytosis. Furthermore, our case stresses the importance of maintaining a broad differential diagnosis in patients living with HIV/AIDS who present with sepsis.
一名30岁的洪都拉斯男性，最近被诊断出患有艾滋病，出现了1个月的腹痛、腹泻和发热症状加重的病史。初步检查发现巨细胞病毒血症和弥漫性淋巴结病。腋窝淋巴结活检显示坏死性淋巴结炎伴播散性组织胞浆菌病。尽管进行了积极的抗菌治疗，但他的临床状况仍持续恶化，这引发了对噬血细胞性淋巴组织细胞增生症的怀疑。该患者符合8项HLH-2004诊断标准中的5项，并按照HLH-94方案成功接受了地塞米松和依托泊苷治疗。尽管艾滋病毒/艾滋病患者中噬血细胞性淋巴组织细胞增生症的死亡率很高且临床结果不佳，但该病例表明，这一高危患者群体可以成功治疗并存活于获得性噬血细胞性淋巴组织细胞增生症。此外，我们的病例强调了对出现败血症的艾滋病毒/艾滋病患者进行广泛鉴别诊断的重要性。
