Indian Journal of Critical Care Case Report

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VOLUME 3 , ISSUE 1 ( January-February, 2024 ) > List of Articles


A Rare Case of CMV-induced HLH in B-ALL

K Krishna Chaitanya

Keywords : Case report, Hemophagocytic lymphohistiocytosis, Septic shock, Steroid

Citation Information : Chaitanya KK. A Rare Case of CMV-induced HLH in B-ALL. 2024; 3 (1):14-17.

DOI: 10.5005/jp-journals-11006-0085

License: CC BY-NC 4.0

Published Online: 30-12-2023

Copyright Statement:  Copyright © 2024; The Author(s).


Hemophagocytic lymphohistiocytosis (HLH) is a condition that demands a high index of suspicion and necessitates differentiation from sepsis as the treatment approaches for these two conditions diverge. Patients afflicted with hematological malignancies are susceptible to developing secondary HLH syndrome, which can arise either due to the malignancy itself or due to infections that emerge during chemotherapy. Prudent administration of chemotherapy regimens and the early identification of secondary HLH, whether attributed to malignancy or to infections, are pivotal in tailoring appropriate treatments and thereby mitigating mortality. This case involves a 50-year-old male diagnosed with B-cell acute lymphoblastic leukemia (B-ALL) and undergoing induction chemotherapy. The patient exhibited refractory shock without discernible sources of infection on routine cultures, along with normal procalcitonin levels. Additionally, acute liver failure and pancytopenia developed. Through diagnostic investigations, hemophagocytes were identified in bone marrow biopsy, and cytomegalovirus (CMV) viral load was detected in the blood, satisfying the Histiocyte Society's criteria for HLH. HLH often mimics sepsis, even though it can itself be triggered by an infection. Hence, it is imperative to accurately identify, differentiate, and treat both conditions appropriately.

  1. Rolsdorph LÅ, Mosevoll KA, Helgeland L, et al. Concomitant hemophagocytic lymphohistiocytosis and cytomegalovirus disease: a case based systemic review. Front Med (Lausanne) 2022;9:819465. DOI: 10.3389/fmed.2022.819465
  2. Reiner AP, Spivak JL. Hematophagic histiocytosis. A report of 23 new patients and a review of the literature. Medicine (Baltimore) 1988;67(6):369–388.
  3. Atim-Oluk M. Cytomegalovirus associated haemophagocytic lymphohistiocytosis in the immunocompetent adult managed according to HLH-2004 diagnostic using clinical and serological means only. Eur J Microbiol Immunol (Bp) 2013;3(1):81–89. DOI: 10.1556/EuJMI.3.2013.1.12
  4. Ljungman P, de la Camara R, Robin C, et al. Guidelines for the management of cytomegalovirus infection in patients with haematological malignancies and after stem cell transplantation from the 2017 European Conference on Infections in Leukaemia (ECIL 7). Lancet Infect Dis 2019;19(8):e260–e272. DOI: 10.1016/S1473-3099(19)30107-0
  5. Ozbalak M, Mastanzade MG, Gurel E, et al. Cytomegalovirus reactivation during adult acute lymphoblastic leukemia maintenance: do we underestimate (un)expected guest of pediatric approach? Am J Blood Res 2021;11(1):118–122.
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