An Unusual Case of Hemophagocytic Lymphohistiocytosis Presentation in Acute Human Immunodeficiency Virus

Abstract

Hemophagocytic lymphohistiocytosis (HLH) in acute human immunodeficiency virus (HIV) patients has been scarcely reported in the English literature. To the best of our knowledge, only 12 cases have been described. We present a case of a 27-year-old male with no past medical history who was admitted with a new-onset headache, fever, night sweats, and chills. Further laboratory tests revealed transaminitis, leukopenia, thrombocytopenia, positive HIV antigen/antibody test, and markedly elevated ferritin levels, which promoted our suspicion of HLH. This case demonstrates HLH as an unusual presentation of HIV during its seroconversion stage. This report adds a rare disease process to the available literature, and we emphasize that markedly elevated ferritin levels in acute HIV patients should raise suspicion toward a diagnosis of HLH.

Emotional and Clinical Challenges of Delayed HIV Seroconversion

“…The delayed seroconversion observed in this clinical case raises concerns regarding the dynamics of HIV infection and diagnosis. Unlike most cases of PHI, where seroconversion typically occurs within a few weeks of viral exposure, seroconversion in this patient occurred later, after a severe diarrheal episode in September 2022 [9][10][11][12]. The unusual delay in seroconversion suggests that the HIV infection in this patient may have been atypical in terms of viral replication and immune response [1,3,4].…”

“…The precise reasons for the delay in seroconversion remain uncertain, although it may be linked to the unique interplay between the virus and the individual's immune response. In rare cases, HIV may exhibit slower and less aggressive viral replication, which could delay the detection of specific antibodies in conventional diagnostic tests [9][10][11][12]. This delay in seroconversion emphasises the importance of continuous surveillance and regular HIV testing, especially in individuals with a potential risk of exposure [1,3,4].…”

Macrophage Activation Syndrome in Viral Sepsis

“…In HIV-positive patients, HLH can manifest as a complication in various diseaserelated clinical scenarios. Firstly, HLH may develop during acute HIV infection [64,96,97]. Secondly, it can be triggered by opportunistic infections to which HIV-positive patients are predisposed [98][99][100].…”