Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome caused by macrophages and cytotoxic T cells with aberrant activation. The primary (genetic) form, which is caused by mutations that affect lymphocyte cytotoxicity and immune regulation, is most prevalent in children, whereas the secondary (acquired) form is prevalent in adults. Secondary HLH is commonly caused by infections or cancers, but it can also be caused by autoimmune disorders, in which case it is known as macrophage activation syndrome (MAS; or MAS-HLH). A 25-year-old female presented with a high-grade fever that lasted for two weeks. His laboratory results revealed pancytopenia, neutropenia, hypertriglyceridemia, hypofibrinogenemia, and hyperferritinemia. Based on the clinical presentation and laboratory findings, a provisional diagnosis of HLH has been made. A HLH protocol was utilized to treat the patient. During the course of hospitalization, systemic lupus erythematosus (SLE) was identified as the underlying cause. She improved dramatically after receiving an immunosuppressive regimen of etoposide, cyclosporine, and dexamethasone according to HLH protocol-2004 with individualized modifications. The clinician should be aware that HLH may be the initial manifestation of underlying SLE. Early diagnosis and aggressive, individualized treatment are the key to improving outcomes.
Tumour-induced osteomalacia due to thymolipomaTumour-induced osteomalacia (TIO) is a rare paraneoplastic syndrome due to secretion of fibroblast growth factor-23 (FGF-23) from tumours located in extremities or head and neck and rarely in the thorax. [1][2][3][4] We report a patient with TIO caused by a thymus tumour. The patient recovered following resection.A 31-year-old woman presented with bilateral hip and thigh pain with difficulty in walking for the past 4 years. She was bedridden but did not suffer from any other systemic illness or fractures. Neurological
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