Hemophagocytic Lymphohistiocytosis Associated with Salmonella typhi Infection in a Child: A Case Report with Review of Literature

Table 1

Characteristics or reported pediatric cases of HLH secondary to typhoid fever.

	This case report (Colombia)	Fame et al. [4] (USA)	Chien et al. [5] (Taiwan)	Caksen et al. [6] (Turkey)	Runel-Belliard et al. [2] (Comoros)	Pandey et al. [3] (India)
Patient	8-year-old girl	13-year-old girl	13-year-old boy	6-year-old boy	7-year-old boy	10-year-old boy
Fever	20 days	14 days	7 days	10 days	8 days	5 days
Hepatomegaly/splenomegaly	+/+	+/+	+/−	−/+	−/+	+/+
Other clinical findings	Abdominal pain, jaundice, right pleural effusion, upper GI bleed	Somnolence	Psychosis, brain edema, maculopapular rash	Abdominal pain, jaundice, headache, hyponatremia	Dysenteric diarrhea, abdominal pain, hyponatremia	Meningeal signs
Hemoglobin (g/dL)	5.8	7.7	10.6	6.9	7.3	6.9
WBC (cells/μL)	2.590	3.300	2.940	3.400	1.300	800
Neutrophils (cells/μL)	1.445	2.145^a	2.499	—	700	—
Platelets per μL	101.000	20.000	20.000	48.000	18.000	10.000
Transfusion support required	Yes	No	No	No	Yes	Yes
AST/ALT (U/L)	349/135	160/31	746/–	433/98	—	—
Ferritin (ng/mL)	>2.000	—	—	—	—	1791
Fibrinogen (mg/dL)	311	—	—	—	105	—
Triglycerides (mg/dL)	787	—	350	—	251	265
Hemophagocytosis	No	Yes	Yes	Yes	—	Yes
Soluble IL-2 receptor	—	—	—	—	—	—
NK activity	—	—	—	—	—	—
Treatment	Ciprofloxacin IVIG	Ampicillin TMP-SMZ^b	Ceftriaxone	Chloramphenicol	Ceftriaxone fluoroquinolone	Ceftriaxone
Time to improvement	5 days	5 days	3 days^c	—	6 days	5 days

WBC = white blood cells; AST = aspartate transaminase; ALT = alanine transaminase; IL-2 = interleukin 2; NK = natural killer; IVIG = intravenous immunoglobulin; TMP-SMZ = trimethoprim sulfamethoxazole. ^aFirst course of ampicillin for 10 days, relapse with the same strain. ^bFirst course with ampicillin for 10 days, relapse with the same strain treated with TMP-SMZ for 14 days. ^cNeurologic symptoms improved after 3 days, fever after 10 days.