Desperate times, desperate measures: successful use of chemotherapy in treatment of haemophagocytic lymphohistiocytosis (HLH) due to disseminated histoplasmosis.

Authors :: Singh SRK
Thanikachalam K
Donthireddy V
Source :: BMJ case reports [BMJ Case Rep] 2020 Sep 02; Vol. 13 (9). Date of Electronic Publication: 2020 Sep 02.
Publication Year :: 2020
Abstract: We describe a case of haemophagocytic lymphohistiocytosis (HLH) secondary to disseminated histoplasmosis, which was treated with chemotherapy in addition to standard antifungal therapy. While HLH in the setting of infections is very well described, its treatment in this setting is controversial, with some physicians treating only the underlying infection, whereas others using immune suppression in addition to antimicrobials. To the best of our knowledge, this is the first report documenting the successful treatment of an adult patient with HLH due to disseminated histoplasmosis using etoposide chemotherapy after initial antifungal therapy failed to show improvement.<br />Competing Interests: Competing interests: None declared.<br /> (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Subjects :: Abdominal Pain drug therapy
Abdominal Pain etiology
Adult
Amphotericin B therapeutic use
Antifungal Agents therapeutic use
Biopsy
Bone Marrow microbiology
Bone Marrow pathology
Dexamethasone therapeutic use
Diagnosis, Differential
Drug Therapy, Combination methods
Encephalitis, Viral diagnosis
Female
Fever drug therapy
Fever etiology
Histoplasmosis complications
Histoplasmosis drug therapy
Histoplasmosis microbiology
Humans
Invasive Fungal Infections complications
Invasive Fungal Infections drug therapy
Invasive Fungal Infections microbiology
Lymphohistiocytosis, Hemophagocytic diagnosis
Lymphohistiocytosis, Hemophagocytic microbiology
Meningitis diagnosis
Nausea drug therapy
Nausea etiology
Treatment Outcome
Etoposide therapeutic use
Histoplasma isolation & purification
Histoplasmosis diagnosis
Invasive Fungal Infections diagnosis
Lymphohistiocytosis, Hemophagocytic drug therapy

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