Hemophagocytic Lymphohistiocytosis (HLH) is a rare, highly aggressive syndrome involving dysregulated immune response. Most cases are secondary to underlying diseases including infections, autoimmune disorders and malignancies. The burden of disease of histoplasmosis and leishmaniosis associated with advanced HIV is still significant in low-and-middle income countries (LMIC). We present a case of histoplasmosis and leishmaniasis associated HLH in a man with an AIDS diagnosis.
CarterSJTattersallRSRamananAV. Macrophage activation síndrome in adults: recent advances in pathophysiology, diagnosis and treatment. Rheumatology2018; 58: 5–17. DOI: 10.1093/rheumatology/key006
2.
AsanadSCerkBRamirezV. Hemophagocytic lymphohistiocytosis (HLH) secondary to disseminated histoplasmosis in the setting of Acquired Immunodeficiency Syndrome (AIDS). Med Mycol Case Rep2018; 20: 15–17.
3.
LoganantharajNOliverBSmithT, et al.Hemophagocytic lymphohistiocytosis in an HIV-positive patient with concomitant disseminated histoplasmosis. Int J STD AIDS2018; 0(0): 1–4.
4.
PaglianoPEspositoS. Visceral leishamiosis in immunocompromised host: an update and literature review. J Chemother2017; 29: 261–266. DOI: 10.1080/1120009X.2017.1323150
5.
StaffolaniSBuonfrateDAnghebenA, et al.Acute histoplasmosis in immunocompetent travelers: a systematic review of literature. BMC Infect Dis2018; 18: 673.
6.
AIDS info. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV, https://aidsinfo.nih.gov/guidelines
7.
VII Consenso Argentino de Terapia Antirretroviral. Comisión de SIDA-SADI 2018-2019.
8.
World Health Organization. Guidelines for diagnosing and managing disseminated histoplasmosis among people living with HIV. Published online April 1, 2020.
9.
AllenCEMcClainKL. Pathophysiology and epidemiology of hemophagocytic lymphohistiocytosis. ASH Education Book2015; 20151: 177–182.
10.
HenterJIHorneACAricóM, et al.HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer2007; 48(2): 124–131.
11.
RanjanPKumarVGangulyS, et al.Hemophagocytic Lymphohistiocytosis Associated with Visceral Leishmaniasis: Varied Presentation. Indian J Hematol Blood Transfus2016; 32(Suppl 1): S351–S354.
12.
WangYWangZ. Treatment of hemophagocytic lymphohistiocytosis. Curr Opin Hematol2017; 24: 54–58.
13.
Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). 2016.
14.
HageCAzarMLoydJ, et al.Histoplasmosis: Up-to-Date Evidence-Based Approach to Diagnosis and Management. Semin Respir Crit Care Med2015; 36(5): 729–745.
15.
PatelKKPatelAKSardaP, et al.Immune reconstitution visceral leishmaniasis presented as hemophagocytic syndrome in a patient with AIDS from a nonendemic area: a case report. J Int Assoc Phys AIDS Care (Chic)2009; 8(4): 217–220.
16.
De LavaissièreMManceronVBouréeP, et al.Reconstitution inflammatory syndrome related to histoplasmosis, with a hemophagocytic syndrome in HIV infection. J Infect2009; 58(3): 245–247.
17.
Reyes-CorchoABouza-JiménezY. Síndrome de reconstitución inmunológica asociado al virus de la inmunodeficiencia humana y sida. Estado del arte. Enferm Infecc Microbiol Clin2010; 28(2): 110–121.
18.
VinhaesCAraujo-PereiraMTibúrcioR, et al.Systemic Inflammation Associated with Immune Reconstitution Inflammatory Syndrome in Persons Living with HIV. Life2021; 11: 65.
19.
ManfrediRMazzoniAPileriS, et al.Simultaneous Occurrence of Visceral Leishmaniasis and Disseminated Histoplasmosis in an Italian Patient with HIV Infection. Infection1994; 22(3): 224–225.
