Case report: Hemorrhagic fever with renal syndrome presenting as hemophagocytic lymphohistiocytosis

Hemophagocytic lymphohistiocytosis may occur in patients with genetic predisposition and in sporadic cases due to malignancy or infection. We describe a 49-year old man with hemorrhagic fever, type 1 respiratory insufficiency and acute kidney injury. Diagnostic work up showed a hyperinflammatory syndrome, hypertriglyceridemia, hemophagocytosis, very high ferritin and significantly elevated sCD25. The findings were compatible with hemophagocytic lymphohistiocytosis based on the HLH-2004 criteria. Serological testing indentified Puumala virus as the causal pathogen. The patient was successfully treated with pulse corticosteroids, intravenous immunoglobins and supportive therapy.

Automated summary

This article describes a case of hemophagocytic lymphohistiocytosis caused by Puumala virus, presenting symptoms such as hemorrhagic fever, respiratory insufficiency, and acute kidney injury. The patient's condition was successfully managed with pulse corticosteroids, intravenous immunoglobins, and supportive therapy.