Hemophagocytic syndrome, a rare complication in patients with human immunodeficiency virus (HIV) infection. A case report

Abstract

Hemophagocytic syndrome secondary to human immunodeficiency virus (HIV) constitutes a rare manifestation of this disease, characterized by nonspecific symptoms that often lead to delayed diagnosis, thereby limiting opportunities for early intervention.

Clinical case: We present the case of a 39-year-old man with a history of HIV diagnosed over ten years ago, who exhibited poor adherence to antiretroviral therapy (ART) and had restarted ART one month prior to his emergency admission due to a five-day history of symptoms. These symptoms included respiratory manifestations, fever, general malaise, and diarrhea. Physical examination revealed constitutional syndrome, stable vital signs, dehydration without the need for supplemental oxygen, no signs of abdominal peritoneal irritation, and large, bilateral, painless inguinal and cervical lymphadenopathies. A previous cervical lymph node biopsy had revealed a hematolymphoid neoplasm of large cells, consistent with non-Hodgkin lymphoma. Paraclinical studies showed severe leukopenia, normocytic anemia, chest X-ray with no evidence of pneumonic consolidation, and a positive RT-PCR for SARS-CoV-2. Due to elevated severity markers, an angiotomography was performed, which evidenced pulmonary thromboembolism (PTE). Tuberculosis studies were negative. Taken together, these findings suggested a high probability of hemophagocytic syndrome, based on the H-score.