2026 Volume 63 Issue 3 Pages 255-260
We report a case of a 5-month-old female diagnosed with multisystem Langerhans cell histiocytosis (MS-LCH) involving at-risk organs. Although initial therapy provided temporary disease control, the patient relapsed, requiring salvage treatment. After therapy, she developed simultaneous infections with SARS-CoV-2, norovirus, and adenovirus, followed by progressive cytopenia and liver dysfunction. She was diagnosed with secondary hemophagocytic lymphohistiocytosis (HLH) and treated using the HLH-2004 protocol, supplemented by tocilizumab. The disease progressed despite intensive management, leading to multiorgan failure and death. This case highlights the vulnerability of patients with LCH to severe viral infections and secondary HLH during intensive immunosuppressive therapy. We emphasize the importance of early recognition and prompt intervention for HLH in such cases, discuss this case in the context of previously reported literature.
