A recent clinical challenge (Gastroenterol 2013; 145: 289, 489) regarding a a 78-year-old with a 12-year history of ulcerative colitis serves as a good reminder to remember hemophagocytic lymphohistiocytosis (HLH) in inflammatory bowel disease patients with high fever, even in the presence of recognized viral infections like cytomegalovirus and Epstein-Barr virus which can trigger HLH. Patients receiving immunosuppressive medications are at risk.
Other clinical points:
- Consider HLH when cytopenias are present in addition to fever
- Ferritin values >10,000 mcg/L serves as a good screen
Take-home point: HLH has a significant mortality rate. Quick recognition can improve outcome.
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