Hemophagocytic Lymphohistiocytosis and Fibroblast Growth Factor 23 (FGF23)-Induced Hypophosphatemia.
Martina Cacciapuoti, Jehan Z Bahrainwala, Wen-Kai Weng et al.
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Case in brief
A patient with acute lymphoblastic leukemia developed severe, refractory hypophosphatemia characterized by renal phosphate wasting, triggered by hemophagocytic lymphohistiocytosis. The diagnosis was established early in the course of leukemia, with exacerbation following chimeric antigen receptor T-cell therapy. Elevated levels of fibroblast growth factor 23 (FGF23) were identified, suggesting a link between inflammation and phosphate metabolism.
What made this case unusual
The case highlights the association of hemophagocytic lymphohistiocytosis with elevated FGF23 levels, contributing to hypophosphatemia, which is not commonly recognized in the context of acute lymphoblastic leukemia.
Diagnostic / clinical pearl
Clinicians should consider renal phosphate wasting and evaluate FGF23 levels in patients with persistent hypophosphatemia, especially following chimeric antigen receptor T-cell therapy.
Why it matters
Understanding the role of inflammation in FGF23 regulation may improve management strategies for hypophosphatemia in hematologic malignancies.