Infection associated hemophagocytic lymphohistiocytosis: a report of three cases

Magesh Kumar, Dharmesh ., D. B. Santra, Chirag Jain


HLH (Hemophagocytic lymphohistiocytosis) is not an uncommon disorder; it is an overreaction of the immune system. It can be familial or acquired and both share one common feature of a highly stimulated and ineffective immune response. Acquired HLH is commonly seen with infection (infection associated hemophagocytic syndrome-IAHS); malignancies and rheumatic disease where it is also known as (macrophage activating syndrome). Here we are reporting three cases of secondary HLH associated with dengue, typhoid and vivax malaria.



Secondary HLH, Infection, Dengue, Enteric, Malaria

Full Text:



George MR. Hemophagocytic lymphohistiocytosis: review of etiologies and management. J Blood Med. 2014;5:69-86.

Ishii E. Hemophagocytic Lymphohistiocytosis in Children: Pathogenesis and Treatment. Front. Pediatr. 2016;4:47.

Dhote R, Simon J, Papo T, Detournay B, Sailler L, Andre MH, et al. Reactive hemophagocytic syndrome in adult systemic disease: report of twenty-six cases and literature review. Arthritis Rheum. 2003;49(5):633-9.

Ray U, Dutta S, Mondal S, Bandyopadhyay S. Severe dengue due to secondary hemophagocytic lymphohistiocytosis: A case study. ID Cases. 2017;8:50-3.

Ellis EM, Sharp TM, Pérez-Padilla J, González L, Poole-Smith BK, Lebo E, et al. Incidence and Risk Factors for Developing Dengue-Associated Hemophagocytic Lymphohistiocytosis in Puerto Rico, 2008 - 2013. PLoS Negl Trop Dis. 2016;10(8):e0004939.

Raju S, Kalyanaraman S, Swaminathan K, Nisha A, Praisid S. Hemophagocytic lymphohistiocytosis syndrome in Dengue hemorrhagic fever. Indian J Pediatr. 2014;81(12):1381-3.

Bhattacharya D, Angurana SK, Nallasamy K, Iyer R, Jayashree M. Severe Dengue and Associated Hemophagocytic Lymphohistiocytosis in PICU. Indian J Pediatr. 2019;86(12):1094-8.

Non LR, Patel R, Esmaeeli A, Despotovic V. Typhoid Fever Complicated by Hemophagocytic Lymphohistiocytosis and Rhabdomyolysis. Am J Trop Med Hyg. 2015;93(5):1068-9.

George N, Sethi P, Nischal N, Kumar A, Siripurapu G, Wig N, Vyas S. A Catastrophic Presentation of Enteric Fever with Secondary Hemophagocytic Lymphohistiocytosis. J Assoc Physicians India. 2018;66(12):11-2.

Amireh S, Shaaban H, Guron G. Severe Plasmodium vivax cerebral malaria complicated by hemophagocytic lymphohistiocytosis treated with artesunate and doxycycline. Hematol Oncol Stem Cell Ther. 2018;11(1):34-7.