Korean J Med.  2016 Aug;91(1):79-83. 10.3904/kjm.2016.91.1.79.

Hemophagocytic Lymphohistiocytosis Occurring after Induction Chemotherapy in Acute Myelocytic Leukemia

• Yoon JA
• Jeon MK
• Kang SM
• Oh E
• Shin SH
• Kim S
• Lee JH

• KMID: 2345590
• DOI: http://doi.org/10.3904/kjm.2016.91.1.79

Abstract

Hemophagocytic lymphohistiocytosis (HLH), associated with acute myelocytic leukemia (AML), is a very rare disease. We here report a case of HLH occurring after induction chemotherapy for AML. AML-associated HLH can be triggered by AML itself, by chemotherapeutic agents, or by infectious complications. Our patient developed a high-grade fever of unknown cause, bilateral pulmonary infiltrates, and shock after successful treatment of AML with induction chemotherapy, and had high serum ferritin, hypertriglyceridemia, hypofibrinogenemia, hemophagocytic histiocytes in bone marrow, low natural killer cell activity, and elevated soluble interleukin-2 receptor levels. A diagnosis of HLH was made. Dexamethasone, cyclosporine, and etoposide were given and allogeneic hematopoietic stem cell transplantation was performed. Careful suspicion of HLH may be warranted if a patient experiences fever of unknown etiology, high ferritin levels, and liver dysfunction during AML treatment.

Keyword

Leukemia, Myeloid, Acute; Lymphohistiocytosis, Hemophagocytic; Induction chemotherapy

MeSH Terms

Bone Marrow
Cyclosporine
Dexamethasone
Diagnosis
Etoposide
Ferritins
Fever
Hematopoietic Stem Cell Transplantation
Histiocytes
Humans
Hypertriglyceridemia
Induction Chemotherapy*
Interleukin-2
Killer Cells, Natural
Leukemia, Myeloid, Acute*
Liver Diseases
Lymphohistiocytosis, Hemophagocytic*
Rare Diseases
Shock
Cyclosporine
Dexamethasone
Etoposide
Ferritins
Interleukin-2