Hemophagocytic lymphohistiocytosis secondary to disseminated histoplasmosis, cytomegalovirus viremia, and nontuberculous mycobacteria bacteremia in a patient with recently diagnosed AIDS

Hemophagocytic lymphohistiocytosis secondary to histoplasmosis: A case report in a patient with AIDS and recent SARS-CoV-2 infection and minireview

“…A literature search for histoplasmosis associated with HLH in HIV-positive patients yielded 33 papers describing 65 AIDS patients with histoplasmosis and reactive hemophagocytosis. The results are shown in Table 1 [ 10 , 11 , 18 , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] ]. Sex was reported in 60 patients, of whom 45 were male.…”

“…Anecdotal cases were initially refractory to treatment with amphotericin B and other medications, such as anakinra, an interleukin-1 receptor antagonist [ 41 ]. Etoposide was administered in only two cases [ 26 , 31 ], and corticosteroids and/or IVIG were administered in 20 patients. However, although it is recommended to treat overt inflammation of HLH with corticosteroids with or without IVIG [ 51 ] in HIV patients, we believe that prompt anti-infective therapy is the milestone for reactive HLH treatment, as documented in our case.…”