Secondary Hemophagocytic Lymphohistiocytosis Triggered by Mixed Plasmodium spp. and SARS-CoV-2 Coinfection.
Adelmo Henrique Daumas-Gabriel, Yara Leite Adami, Hye Chung Kang
✦ AI-curated · Sources linked
Case in brief
A patient with mixed Plasmodium vivax and P. falciparum malaria acquired in Mato Grosso, Brazil, and concomitant SARS-CoV-2 infection presented in nonendemic Macaé with high fever and pancytopenia. Hypertriglyceridemia and hyperferritinemia, together with hemophagocytosis on bone marrow aspirate, supported secondary hemophagocytic lymphohistiocytosis (HLH). The patient met six of eight HLH-2004 criteria, and the HScore indicated a high probability of secondary HLH. Recovery followed initiation of antimalarial and corticosteroid therapies.
What made this case unusual
Secondary HLH occurred with concurrent mixed P. vivax/P. falciparum malaria and SARS-CoV-2 infection, with malaria diagnosed outside an endemic region.
Diagnostic / clinical pearl
In a patient with fever and pancytopenia, hypertriglyceridemia, hyperferritinemia, and marrow hemophagocytosis can support HLH; assess for overlapping infections, including malaria and SARS-CoV-2.
Why it matters
The case highlights that malaria may be diagnosed outside endemic areas and that concurrent parasitic and viral infections may contribute to HLH, making recognition of both infections relevant to timely diagnosis and management.