A 3-year-old previously healthy boy was admitted because of a 1-week
history of
fever,
abdominal pain,
vomiting, and
diarrhea. The initial
laboratory tests showed hepatic dysfunction with
disseminated intravascular coagulation. There was a large amount of
pleural effusion, periportal
edema, minimal
ascites, and
splenomegaly. He was initially managed with broad spectrum
antibiotics with transfusion. Despite 2 days of
treatment, the
fever persisted and the results of the
laboratory tests had worsened. Bacterial
cultures from the
blood,
urine,
pleural effusion, and
ascites were all negative. He was finally diagnosed with
hemophagocytic lymphohistiocytosis (HLH) based on the diagnostic criteria.
Adenovirus was detected in the initial
diarrhea and nasal swab specimens using
polymerase chain reaction-based
method. One year after
chemotherapy with
dexamethasone,
cyclosporine, and
etoposide, he is now healthy without evidence of
disease recurrence. This is the first Korean case
report of
adenovirus-induced HLH in a previously healthy
child.