Hemophagocytic lymphohistiocytosis associated with acute otitis media: A case report

• Published in: Medicine (Baltimore) Vol. 103; no. 25; p. e38616
• Main Authors: Chung, Da Hyun, Lee, Kyu-Yup, Kim, Ji-Yoon, Jung, Da Jung
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 21.06.2024
• Subjects: Acute Disease; Child, Preschool; Clinical Case Report; Cyclosporine - administration & dosage; Cyclosporine - therapeutic use; Dexamethasone - administration & dosage; Dexamethasone - therapeutic use; Etoposide - administration & dosage; Etoposide - therapeutic use; Humans; Immunoglobulins, Intravenous - therapeutic use; Lymphohistiocytosis, Hemophagocytic - complications; Lymphohistiocytosis, Hemophagocytic - diagnosis; Lymphohistiocytosis, Hemophagocytic - drug therapy; Lymphohistiocytosis, Hemophagocytic - etiology; Male; Otitis Media - complications; Otitis Media - drug therapy
• ISSN: 0025-7974; 1536-5964; 1536-5964
• DOI: 10.1097/MD.0000000000038616

Hemophagocytic lymphohistiocytosis (HLH) is a potentially life-threatening syndrome for which early recognition and treatment are essential for improving outcomes. HLH is characterized by uncontrolled immune activation leading to fever, cytopenias, hepatosplenomegaly, coagulation abnormalities, and elevated typical markers. This condition can be genetic or secondary, with the latter often triggered by infections. Here, we present a unique case of HLH secondary to acute otitis media (AOM), a common ear infection. We describe a 4-year-old boy who initially presented with a high fever and otalgia, later diagnosed with bilateral AOM. Despite antibiotic treatment, his condition deteriorated. The patient fulfilled diagnostic criteria for HLH. Aggressive treatment by using combination therapy with immunoglobulins, intravenous steroids (dexamethasone), cyclosporine, and etoposide was performed. After 1 month of treatment, improvement in the otologic symptoms was observed, and hematological findings gradually improved and normalized. The link between AOM and HLH may be associated with inflammatory responses and immunological mechanisms, highlighting the importance of considering HLH in severe infection cases. This case emphasizes the need for prompt diagnosis and management, especially in secondary HLH scenarios, to improve patient outcomes. It is imperative to be aware of the potential correlation between these 2 conditions, and healthcare professionals should consider the likelihood of HLH.