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.

Malaria-associated secondary hemophagocytic lymphohistiocytosis: A case report

“…Malaria as a cause of secondary HLH is rare. We reviewed the related literature, and fewer than 20 cases have been reported[ 7 - 14 ]. There are no similar cases reported in China.…”

“…The reason for this is that on the one hand, China is not a malaria-endemic area, and on the other hand, some cases have not been recognized and diagnosed. The types of malarial parasites that cause secondary HLH are P. falciparum and P. vivax [ 7 , 13 ], with P. falciparum accounting for most of these cases. The pathogenesis is not yet clear but may be related to immune dysfunction caused by falciparum malaria.…”

Collapsing Focal Segmental Glomerulosclerosis with Acute Interstitial Nephritis Associated with Plasmodium Falciparum: A Case Report and Review of the Literature

“…Treatment with corticosteroids should be considered only when given as therapy for extrarenal manifestations after the parasite is eradicated. For example, corticosteroids have been utilized in the treatment of encephalitis and in the hemophagocytic syndrome accompanying malaria [12,13].…”

Falciparum malaria-induced secondary hemophagocytic lymphohistiocytosis successfully treated with ruxolitinib

“…Secondary hemophagocytic lymphohistiocytosis (sHLH) is a rare hyperinflammatory complication of different hematopoietic, autoimmune, and infectious diseases (Morimoto et al, 2016), including falciparum malaria (Ohnishi et al, 2007;Vinoth et al, 2011;Bhagat et al, 2014;Harioly Nirina et al, 2017). The clinical picture includes fever, hepatosplenomegaly, and pancytopenia (Ramos-Casals et al, 2014).…”