Medical image of the week: hemophagoctyic lymphohistiocytosis (HLH)

• Main Authors: Tauseef Afaq Siddiqi, Carlos Tafich Rios, Carlos L Cantu, James Knepler, Linda Snyder
• Format: Article
• Language: English
• Published: Arizona Thoracic Society 2013-12-01
• Series: Southwest Journal of Pulmonary and Critical Care
• Subjects: hemophagocytic lymphohistocytosis; HLH; lymphoma; B cell; ferritin; respiratory failure; shock; multisystem organ failure; sepsis; erythrophagocytosis
• Online Access: http://www.swjpcc.com/imaging/2013/12/18/medical-image-of-the-week-hemophagocytic-lymphohistiocytosis.html

No abstract available. Article truncated at 150 words. A 41-year-old African American woman with a history of diffuse large B cell lymphoma in remission was admitted to the hospital with severe dyspnea and abdominal pain. Recent imaging revealed extensive pulmonary and liver nodules with significant mediastinal lymphadenopathy (Figures 1 and 2). She had an extensive outpatient evaluation of these abnormalities including multiple percutaneous and endoscopic biopsies which were nondiagnostic. She deteriorated clinically and a ferritin level was elevated at 36,284 ng/mL. Due to the markedly elevated ferritin, a bone marrow biopsy was performed and was normocellular with trilineage hematopoiesis and erythrophagocytosis consistent with hemophagocytic lymphohistiocytosis (HLH, Figure 3). A VATS guided lung biopsy was performed revealing recurrence of the diffuse large B cell lymphoma (Figure 4). She started chemotherapy with the E-SHAP (etoposide, methylprednisolone, cytarabine, cisplatin), however, became severely pancytopenic and developed acute respiratory failure, shock and multi-organ failure. She died despite aggressive care in the intensive care …