Malaria-associated secondary hemophagocytic lymphohistiocytosis: A case report

Table 1 The change in clinical and laboratory manifestations before and after treatment

	Reference range	Before treatment	7 d after treatment	14 d after treatment
Temperature (℃)	36-37	Tmax 39.8	No fever	No fever
White blood cells (× 109/L)	3.50-9.50	2.88	3.78	4.33
Neutrophils (× 109/L)	1.8-6.3	1.31	2.15	2.00
Hemoglobin (g/L)	115-150	49	108	93
Platelet count (× 109/L)	125-350	50	112	151
Reticulocytes (× 1012/L)	0.0140-0.0900	0.1443	0.2269	0.0902
Indirect bilirubin (μmol/L)	0.00-12.00	15.44	16.09	8.59
Triglyceride (mmol/L)	0.57-1.70	2.45	2.42	2.23
Ferritin (ng/mL)	11.00-306.00	1989.00	1730	1516
Fibrinogen (ng/mL)	1.70-4.00	1.41	1.31	1.63
NK-cell activity		Negative		-
sCD25 (pg/mL)		21574		4775
Spleen ultrasonography	Length 8.5 ± 1.0 cm	14.2		-
	Thickness 2.8 ± 0.5 cm	3.8		3.4

sCD25: Soluble CD25; NK cell: Natural killer cell.

Table 2 Diagnosis of hemophagocytic lymphohistiocytosis-2004 criteria

The diagnosis of HLH can be established if either condition 1 or condition 2 below is fulfilled

(1) A molecular diagnosis consistent with HLH

(2) Diagnostic criteria for HLH fulfilled (five out of the eight criteria below)

(A) Initial diagnostic criteria (to be evaluated in all patients with HLH)

Fever

Splenomegaly

Cytopenia (affecting ≥ 2 of 3 lineages in the peripheral blood):

Hemoglobin < 90 g/L (in infants < 4 wk: hemoglobin < 100 g/L)

Platelets < 100 × 109/L

Neutrophils < 1.0 × 109/L

Hypertriglyceridemia and/or hypofibrinogenemia:

Fasting triglycerides ≥ 3.0 mmol/L (i.e., ≥ 265 mg/dL)

Fibrinogen ≤ 1.5 g/L

Hemophagocytosis in bone marrow or spleen or lymph nodes

No evidence of malignancy

(B) New diagnostic criteria

Low or absent NK-cell activity (according to local laboratory reference)

Ferritin ≥ 500 µg/L

Soluble CD25 (i.e., soluble IL-2 receptor) ≥ 2400 U/mL

HLH: Hemophagocytic lymphohistiocytosis.