Haemophagocytic lymphohistiocytosis: a cause of unresponsive malaria in a 5-year-old girl

Abstract

A 5-year-old immunocompetent girl presented with fever, jaundice, hepatosplenomegaly and pancytopenia. The peripheral blood smear demonstrated mixed malaria infection (Plasmodium vivax and Plasmodium falciparum). Fever was persistent despite antimalarials in the absence of any coexisting bacterial or viral infection. Laboratory findings included cytopaenia, hyperbilirubinaemia, hyperferritinaemia, hypertriglyceridaemia, hyponatraemia, deranged partial thromboplastin time, decreasing ESR and megaloblastic changes on bone marrow aspiration. A final diagnosis of haemophagocytic lymphohistiocytosis (HLH) with megaloblastic anaemia associated with severe mixed malaria was made. There was a dramatic response to corticosteroid treatment with improvement in her clinical condition. This report endorses the use of corticosteroids in malaria-associated HLH whenever there is no clinical improvement with antimalarials alone.

Complicated Falciparum Malarial ARDS Requiring Noninvasive Support

“…As a result of severe overwhelming inflammation, malaria as well other systemic parasitic infection may rarely induce hemophagocytosis. 5,6 No data are available regarding falciparum ARDS in the presence of hemophagocytosis: the role of hyperinflammation in promoting a gravity-dependent and marked lung compaction pattern cannot be excluded. As reported in our cases, the radiological features of ARDS in falciparum malaria can be quite different depending on the lung compaction degree and fluid overload.…”

A Case Report of Malaria-associated Secondary Hemophagocytic Lymphohistiocytosis and a Review of the Literature

“…Malaria as a cause of secondary HLH is rare. We reviewed the related literature, and fewer than 20 cases have been reported [7]- [21] . There are no similar cases reported in China.…”