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Similar Publications

Fever of Unknown Origin: A Rare Diagnosis Requiring High Suspicion.

Cureus

December 2024

Internal Medicine, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Chaves, PRT.

Fever is a classic reason for hospital visits, sometimes requiring admission. Its etiologies are numerous, ranging from simple and relatively common conditions to rare and complex pathologies, for which the differential diagnosis can present a true challenge for internists. A 78-year-old healthy female is referred to the emergency department due to marked fatigue for the past four months, with no other symptoms.

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A 9-month-old girl was evaluated for recurrent fevers, rash, and indurated plaques, with laboratories demonstrating hyperferritinemia, hypertriglyceridemia, and pancytopenia, concerning for hemophagocytic lymphohistiocytosis. Biopsy of thigh lesion ultimately demonstrated subcutaneous panniculitis-like T-cell lymphoma. In a rare neoplasm of cytotoxic T-cells, subcutaneous panniculitis-like T-cell lymphoma presents with subcutaneous nodules in all age groups including children.

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Macrophage activation syndrome (MAS) can be regarded as a key factor determining the severity of multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C), and often requires treatment in the intensive care unit (ICU) to avoid life-threatening complications. No reputable specific criteria for the diagnosis of MAS in MIS-C patients have yet been identified, and criteria currently used for the diagnosis of hemophagocytic syndromes, such as HLH-2004, MAS-2005, and MAS-2016, are not sufficient for MAS in MIS-C. Our goal in this study was to work out the criteria for the early diagnosis of MAS in MIS-C.

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Hemophagocytic Lymphohistiocytosis Associated With Epstein-Barr Virus Infection in an Immunocompetent Adult.

Cureus

December 2024

Department of Internal Medicine, Unidade Local de Saúde Entre Douro e Vouga, Santa Maria da Feira, PRT.

Hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal entity characterized by an unregulated activation of the immune system. In the adult population, it is most commonly secondary to infectious, autoimmune, or neoplastic diseases. We present a case of a 23-year-old female diagnosed with infectious mononucleosis and hospitalized due to a persistent three-week fever and malaise with a new onset of jaundice and findings compatible with acute hepatitis and hepatosplenomegaly.

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Although herpes simplex virus, Epstein-Barr virus, and hemophagocytic lymphohistiocytosis are known causes of severe acute liver injury with or without liver failure, these diseases occur almost exclusively in immunocompromised and elderly patients. We report a case of an immunocompetent young man with no medical history who presented with a subacute cough and persistent fevers in the setting of a penile chancre. He was found to have severely elevated liver chemistries and was subsequently diagnosed with hemophagocytic lymphohistiocytosis because of disseminated herpes simplex virus type 1 and Epstein-Barr virus coinfection.

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