Abstract
A 4X-year-old man was referred to our emergency department with symptoms including fever, fatigue, shortness of breath, jaundice. Laboratory investigations demonstrated decreased levels of white blood cells and platelets while lactate dehydrogenase (LDH), C-reactive protein, triglyceride and ferritin exhibited significant elevations, which raised the suspicion of secondary Hemophagocytic lymphohistiocytosis (HLH). Despite immediate glucocorticoid pulse therapy and immunoglobulins along with antibiotic, his condition got worse. Therefore, we started continuous hemodiafiltration using a polymethyl methacrylate membrane hemofilter (PMMA-CHDF) on day 2. Subsequently, LDH and ferritin, which are considered as indirect cytokine markers, decreased and the patient’s condition has shown improvement. The day after admission, a bone marrow smear confirmed the diagnosis of HLH. The patient was discharged home with no further symptom. HLH is a severe and often lethal inflammatory syndrome characterized by macrophage activation and hypercytokinemia. Multidisciplinary treatment combined with early introduction of PMMA-CHDF for cytokine removal may control the disease course of HLH.
