Secondary Hemophagocytic lymphohistiocytosis in an immunocompetent adult: a case report distinguishing sarcoidosis from histoplasmosis.
Andrew Hanchosky, Paolo Cuculicchio, Iqra Effendi et al.
✦ AI-curated · Sources linked
Case in brief
A 73-year-old immunocompetent male presented with lethargy and poor oral intake, initially diagnosed with sarcoidosis. Clinical evaluation revealed fever, splenomegaly, pancytopenia, and elevated inflammatory markers. A bone marrow biopsy confirmed disseminated histoplasmosis and secondary hemophagocytic lymphohistiocytosis (HLH). Treatment included liposomal amphotericin B, a dexamethasone taper, and itraconazole for one year, leading to resolution of symptoms.
What made this case unusual
Disseminated histoplasmosis as a rare cause of secondary HLH in an immunocompetent adult is noteworthy, particularly given the initial misdiagnosis of sarcoidosis.
Diagnostic / clinical pearl
Clinicians should consider disseminated histoplasmosis in patients presenting with HLH, especially when initial diagnoses like sarcoidosis are made.
Why it matters
This case underscores the diagnostic challenges in differentiating between histoplasmosis and other granulomatous diseases, emphasizing the need for thorough evaluation in similar presentations.