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Case Reports in Hematology
Volume 2016 (2016), Article ID 4839146, 2 pages
http://dx.doi.org/10.1155/2016/4839146
Case Report

A Rare Cause of Hemophagocytic Lymphohistiocytosis: Fusobacterium Infection—A Case Report and Review of the Literature

1Kansas University Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
2Division of Hematologic Malignancies and Cellular Therapeutics (HMCT), Department of Internal Medicine, University of Kansas Cancer Center, 2330 Shawnee Mission Parkway, Mailstop 5003, Westwood, KS 66205, USA

Received 23 May 2016; Accepted 20 July 2016

Academic Editor: Tatsuharu Ohno

Copyright © 2016 Ghulam Rehman Mohyuddin and Heather J. Male. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome characterized by excessive activation of the immune system. Bacterial infections are very rare precipitants of this disease. A 19-year-old gentleman presented with headache, fatigue, and malaise. He was found to be hypotensive, tachycardic, and febrile. Broad spectrum antibiotics were initiated, and a lumbar puncture ruled out meningitis. Patient progressively developed shock that required use of vasopressors, as well as renal and respiratory failure. Blood cultures grew Fusobacterium necrophorum. Given continued fevers despite appropriate antimicrobials, a bone marrow biopsy was performed revealing increased histiocytes with hemophagocytosis. Dexamethasone was added with dramatic clinical improvement. Our case highlights Fusobacterium as a rare precipitant of HLH and proves that a high index of clinical suspicion is crucial for early diagnosis of HLH, allowing for prompt initiation of HLH-specific immunosuppressive therapy that can be life-saving.