A Case of Death Due to Hemophagocytic Lymphohistiocytosis Accompanied by Scrub Typhus

Hyung Wook Kim; Bo Sik Choi; Jong Hyung Kim; Young Min Shin; Soon Jung Lee; Sung Ryul Kim; Jae-Bum Jun

doi:10.3947/ic.2010.42.4.266

Journal List > Infect Chemother > v.42(4) > 1035024

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Kim, Choi, Kim, Shin, Lee, Kim, and Jun: A Case of Death Due to Hemophagocytic Lymphohistiocytosis Accompanied by Scrub Typhus

Case Report

Infection & Chemotherapy

Infection & Chemotherapy 2010; 42(4): 266-270.

Published online: 30 August 2010

DOI: https://doi.org/10.3947/ic.2010.42.4.266

A Case of Death Due to Hemophagocytic Lymphohistiocytosis Accompanied by Scrub Typhus

Hyung Wook Kim¹, Bo Sik Choi¹, Jong Hyung Kim¹, Young Min Shin¹, Soon Jung Lee¹, Sung Ryul Kim², Jae-Bum Jun¹

¹Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan, Korea.

²Department of Laboratory Medicine, University of Ulsan College of Medicine, Ulsan, Korea.

Correspondence to Jae-Bum Jun, M.D. Department of Internal Medicine, Ulsan University Hospital, 290-3 Jeonha-dong, Dong-gu, Ulsan 682-714, Korea. Tel: +82-52-250-8930, Fax: +82-52-251-8235, uvgotletter@hanmail.net

Received 20 May 2010 Revised 16 June 2010 Accepted 7 July 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hemophagocytic lymphohistiocytosis (HLH) is a rare disease with a high mortality rate. It is associated with a variety of bacterial, viral, fungal, and parasitic infections. In the literature, there are several cases of HLH associated with scrub typhus in adults, all of which were successfully treated with antibiotic therapy for scrub typhus. This report describes a case of HLH accompanied by scrub typhus in an 81-year-old woman, in whom the disease progressed despite doxycyclin therapy. The patient refused to receive immunosuppressive chemotherapy for HLH and died 5 weeks after admission due to multi-organ failure. To our knowledge, this is the first case of death due to scrub typhus-associated HLH in an adult.

Keywords: Scrub typhus, Hemophagocytic lymphohistiocytosis, Hemophagocytic syndrome

Figures and Tables

Figure 1

Contrast-enhanced abdominal computed tomography on admission shows hepatosplenomegaly.

Figure 2

Microscopic finding of bone marrow aspiration shows hemophagocytosis of neutrophil, normoblasts, and platelets (Wright-Giemsa stain, ×1,000).

Table 1

Reported Cses of Hemophagocytic Lymphohistiocytosis Associated with Acrub Typhus in Adults

ANC, absolute neutrophil count; CBC, complete blood cell count; Hb, hemoglobin; LDH, lactic dehydrogenase; WBC, white blood cell; -, not reported

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