S2746 Liver Transaminitis in the Setting of HLH

INTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of a severely increased inflammatory response leading to tissue damage. HLH poses a challenge to clinicians as its presentation tends to overlap with conditions such as sepsis, systemic inflammation, cancer. In most cases, HLH is a result of infection, autoimmune disease & malignancy. Our case seeks to highlight the increasing incidence of HLH in the adult population by following a 76 yo male who presented with persistent diarrhea, pancytopenia, liver transaminitis which was later diagnosed as HLH. CASE DESCRIPTION/METHODS: A 76 yo Caucasian male with a pmhx of CAD, HTN, HLD, C. dif, iron deficiency anemia presented to the hospital with a chief complaint of nausea & diarrhea with an onset 3 wks prior to presentation. The patient noted that his symptoms first started with rhinorrhea, body aches, headaches and a subjective fever measured at 101F. However due to persistent watery diarrhea and weakness for 5 days, he was advised to visit our facility. Pt was admitted as he met sepsis criteria and found to be pancytopenic on admission. There was an initial suspicion that pts pancytopenia was secondary to sepsis that may have been caused by C. dif. He was later found to be C. dif negative. He continued treatment for PNA but continued to be pancytopenic. Heme/Onc was consulted, a bone marrow biopsy was obtained but pts bone marrow did not reveal any underlying pathology. Granix, Restocrit were added with minimal results. His clinical course continued to worsen, now with liver transaminitis and clinical decline requiring transfer to the ICU. HLH was suspected after all broad spectrum treatments had failed and pts CT abd/pelv noted hepatomegaly and splenomegaly. With the CT findings, persistent pancytopenia, Ferritin 10065, & elevated IL-5, HLH was suspected. A Liver bx revealed typical Hodgkins lymphoma which was the underlying cause of HLH. Although a clinical diagnosis was made, pts clinical status had rapidly deteriorated prior to starting life-saving measures and the patient succumbed to his illness. DISCUSSION: This is a case of a 76 year old male who presented with secondary HLH with immune activation in the setting of Hodgkin’s lymphoma and Chronic EBV. HLH is a rapidly progressive condition with a high mortality rate resulting from multiorgan failure. Lately, the incidence in adults has been growing and it is important for clinicians consider the disease in the setting of sepsis, worsening clinical picture & multi-organ failure.