Fatal hemophagocytic syndrome as a manifestation of immune reconstitution syndrome in a patient with acquired immunodeficiency syndrome

ABSTRACT

Hemophagocytic lymphohistiocytosis [HLH] is an aggressive and potentially life-threatening condition characterized by uncontrolled hyper inflammation caused by various inherited or acquired immune deficiencies. We report a case of a 42-year-old man, newly diagnosed with HIV on the basis of a low CD4 T lymphocyte count [17/mm[3]] and HIV viral load >100,000 copies/mL by polymerase chain reaction [PCR] tests undergoing an anti-retroviral regimen [emitricitabine, tenofovir disoproxil fumarate, ritonavir, and darunavir] and opportunistic infection prophylaxis [clarithromycin and atovaquone]. He was concomitantly diagnosed with hemophagocytic syndrome, also known as HLH. He developed increasingly severe pancytopenia while on treatment with anti-retroviral drugs