Hepatitis C Virus Associated Hemophagocytic Lymphohistiocytosis: Case Report and Literature Review

Abstract

A 46-year-old male presented with 10 days of fatigue, jaundice, and bloody sputum. Past medical history was significant for chronic hepatitis C virus (HCV) infection, with viral load > 10 million copies by PCR. Lab work showed severe derangements of multiple organ systems including cytopenias, renal failure, and transaminitis; a bone marrow biopsy revealed hemophagocytosis. On hospital day three he was started on definitive treatment for hemophagocytic lymphohistiocytosis (HLH) consisting of etoposide and dexamethasone, with marked improvement in condition. An exhaustive workup for infectious, rheumatologic, and malignant secondary etiologies was negative. In addition, genetic testing did not reveal a primary defect. We therefore postulate his HLH to be associated with chronic untreated HCV infection, a previously unreported clinical scenario in the literature.




doi: http://dx.doi.org/10.4021/jh82w