Clinical and Biochemical Characteristics of Hemophagocytic Lymphohistiocytosis in People Living With HIV and Disseminated Histoplasmosis at a Tertiary Hospital in Mexico

• Published in: Open forum infectious diseases Vol. 11; no. 7; p. ofae385
• Main Authors: Cruz-Quezada, Arlen, Moreno, Joaquín, Solís-Bravo, Miguel Ángel, López Chávez, Claudia Andrea, Santos, Tiburcio, Fonseca-Mata, Juan José, Araiza, Javier, Bonifaz, Alexandro
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01-07-2024
• Subjects: Infectious Diseases in Special Populations
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofae385

Abstract
Background
Hemophagocytic lymphohistiocytosis (HLH) is considered a rare disease with high morbidity and mortality risks. Most research on this disease is conducted in pediatric settings. Therefore, this study aimed to describe the clinical characteristics, laboratory findings, and outcomes related to HLH in people living with human immunodeficiency virus (HIV)/AIDS) and disseminated histoplasmosis.
Methods
A retrospective and descriptive study was conducted in a tertiary hospital in México City from January 2018 to December 2022, including people living with HIV who had disseminated histoplasmosis confirmed through direct microbiological or immunological methods with an HScore ≥169 or who met 5 of the 8 HLH-2004 criteria.
Results
HLH occurred in 36.1% (n = 26) of patients with HIV and disseminated histoplasmosis; the majority were men (84.9%), and their mean age (standard deviation) was 30.19 (5.6) years. The most frequent clinical manifestations were hepatomegaly (100%), fever (96.2%), and dyspnea (84.6%). The most common biochemical changes were hyperferritinemia (100%), elevated lactate dehydrogenase (100%), and bicytopenia (61.5%). Partial thromboplastin time (P = .012) and prothrombin time (P = .004) were associated with the 30-day mortality rate, and the 30-day survival rate was 65.4%.
Conclusions
We detected a high frequency of HLH; therefore, we encourage physicians to use diagnostic prediction tools (HLH-2004 and HScore criteria) in each reassessment for timely detection.
Hemophagocytic lymphohistiocytosis in people living with HIV and disseminated histoplasmosis is considered rare, and it is potentially fatal. In this review of clinical and biochemical findings, partial thromboplastin time and prothrombin time were associated with 30-day mortality rates.