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Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening syndrome that may be triggered by hereditary factors, autoimmune and immunologic disorders, infectious diseases, malignancies and medications. Suspicion of the disease and early treatment is of paramount importance. Since the presentation of HLH with only skin involvement is rare, early diagnosis may be difficult. A pathologically confirmed HLH case that presented with maculopapular skin lesions after certolizumab treatment is being reported in this presentation. [ABSTRACT FROM AUTHOR]