A rare cause of acquired immune deficiency syndrome related pancytopenia

An Unusual Case of Secondary Hemophagocytic Lymphohistiocytosis in a Patient Diagnosed With Triple Infection: COVID-19, HIV, and Histoplasmosis

In this study, we present a unique instance of a patient who developed hemophagocytic lymphohistiocytosis secondary to a triple infection with coronavirus disease 2019 (COVID-19), HIV, and histoplasmosis. We emphasize the proinflammatory dysregulations driving the severity of COVID-19 infection in this setting and highlight the importance of early diagnosis and targeted therapy of underlying conditions as a method to increase the chance of survival.

Hemophagocytic Lymphohistiocytosis Induced Cytokine Storm Secondary to Human Immunodeficiency Virus Associated Miliary Tuberculosis

Hemophagocytic lymphohistiocytosis (HLH) is a rarely diagnosed fatal inflammatory disease associated with an overactive immune system. It occurs in a host of conditions, with human immunodeficiency virus (HIV) being a rare but serious cause, usually occurring in patients with acquired immunodeficiency syndrome (AIDS). The diagnosis of HLH can be very difficult, as it presents with vague signs and symptoms, which can be present in multiple diseases. This case highlights the diagnostic dilemma faced when treating this potentially fatal condition. Usually, treating the underlying trigger for HLH is sufficient to counteract the overwhelming inflammatory response; however, this can prove to be difficult, as demonstrated in our patient. We present a case of miliary tuberculosis in the setting of HIV/AIDS, complicated by HLH in a young male patient. Whether it was due to delays in treatment or the rapidly fulminant nature of the disease, our patient had a poor clinical outcome. Although rare, tuberculosis-associated HLH must be considered as a cause of secondary HLH in all patients, especially those who are immunosuppressed.

Hemophagocytic lymphohistiocytosis (HLH) secondary to disseminated histoplasmosis in the setting of Acquired Immunodeficiency Syndrome (AIDS)

Hemophagocytic lymphohistiocytosis (HLH) is a rare and aggressive disease involving immune system over-activation leading to hemophagocytosis. HLH requires early diagnosis and prompt treatment initiation, especially in patients with Acquired Immunodeficiency Syndrome (AIDS). We present a case of a middle-aged male with AIDS and renal failure, who developed HLH secondary to disseminated histoplasmosis. Etoposide chemotherapy as recommended by the HLH 2004 Guidelines was deferred and treatment focused instead on anti-fungal therapy. Anti-retroviral therapy followed thereafter.

HHV-8-associated haemophagocytic lymphohistiocytosis in a patient with advanced AIDS

We present a patient with advanced AIDS admitted with recurrent shock of unclear aetiology, fevers, altered mental status and refractory cytopenias. His case posed a diagnostic challenge because evaluation of septic shock in the setting of advanced AIDS requires a time-consuming work-up for broad infectious aetiologies that can delay consideration of other diagnoses, including primary or secondary haemophagocytic lymphohistiocytosis (HLH). After this patient did not improve with supportive care and empiric antimicrobials, there was concern for HLH given that he met ≥5 of the HLH consortium criteria. He underwent bone marrow biopsy, which was non-diagnostic. Empiric therapy for HLH was initiated, but unfortunately, the patient died. Autopsy revealed extensive haemophagocytosis in the spleen, bone marrow and liver, confirming the diagnosis of HLH. Postmortem, his soluble CD-25 returned 18 890 pg/mL (<1033 pg/mL), and his serum HHV-8 PCR resulted positive. The diagnosis was HLH secondary to Human Herpes Virus 8 (HHV-8) in a patient with advanced AIDS.

Successful Treatment of immune Reconstitution Inflammatory syndrome-related Hemophagocytic Syndrome in an HIV Patient with Primary Effusion Lymphoma

Although the connection of [secondary hemophagocytic syndrome (sHS)] with HIV has been well documented, optimal treatment regimen is not well established. This is due not only to the rarity of the syndrome, but also to the heterogeneity of the involved population. Most cases are related to opportunistic infections or malignancies in advanced stage, but many cases are also related to seroconversion, in the primary infection setting. Moreover, in the [antiretroviral treatment (ART)] era, rare cases of ART-related sHS have been reported. In these, often fatal cases, an [immune reconstitution inflammatory syndrome (IRIS)] process is involved, posing a serious challenge to the treating physician. We hereby report a case of successful treatment of an HIV patient with primary effusion lymphoma who experienced sHS shortly after ART onset. Our patient, treated with high dose dexamethasone and gamma globulin, achieved complete remission. This case might hint possible therapeutic insights in the treatment of IRIS-related sHS.

Double-Orifice Tricuspid Valve: A Case Report and Literature Review

Duplication of an atrioventricular valve is a rare congenital anomaly that usually involves the mitral rather than the tricuspid valve (TV). Isolated appearances of a double-orifice TV (DOTV) are extremely rare and in most cases are associated with other congenital anomalies. We report a rare case of an HIV-seropositive male with a DOTV, divided right atrium and Wolff-Parkinson-White syndrome admitted to our hospital with palpitations and dyspnea. After medical therapy, the patient's symptoms were alleviated. We summarized the characteristics of the DOTV and reviewed the literature.