A 33-year-old man with no morbid history consulted for one week of fever and abdominal pain.
As relevant data, her two daughters younger than 5 years had a self-limiting viral respiratory condition during the week prior to the onset of symptoms.
On admission, fever and physical examination were normal.
Laboratory tests showed elevated C-reactive protein (CRP), normal blood count, negative blood and urine cultures and normal biochemical profile.
Chest radiography and computed tomography (CT) of the abdomen and pelvis showed no abnormal findings.
A molecular viral panel of nasopharyngeal swab was requested, which showed the presence of malignancy virus.
Despite symptomatic treatment, the patient remained febrile during the first week of admission and developed painful cervical lymphadenopathy, hand arthralgia and evanescent rash.
Control tests showed abnormal liver tests with a cholestatic pattern, high sedimentation rate, increased CRP, normocytic, regenerative normochromic anemia and thrombocytopenia.
The absence of a diagnostic unit expanded the study with markers of autoimmunity, tests of viral hepatitis and vasculitis, all resulting in normal ranges.
Still's disease was proposed as a possible diagnosis, so we requested high ferritin (1776 IU/L, normal value between 40 and 290 IU/L).
In the following 24 h, ferritin increased to 2,400 UI/L and the patient developed hepatomegaly.
The diagnosis of FAS secondary to viral pathology (para. hemofa 2) was postulated and, with the urgency of obtaining material for histological diagnosis, a spinal cord study was carried out, which showed inflammatory cells by flow cytometry (CMF)
The HLH chemotherapy protocol was started 94.
During hospitalization, the patient suddenly presented with compromised consciousness and respiratory failure requiring conservative treatment.
Magnetic resonance imaging showed a left thalamo-striatal hematoma with minimal midline displacement and mass effect.
The patient presented with spontaneous resolution of the hematoma and motor deficit.
After starting the chemotherapy protocol (QMT) HLH 94, ferritin levels and liver changes progressively normalized.
A patients brother was studied for the possibility of performing allogeneic transplantation of hematopoietic precursors (allo-HSCT) of consolidation or rescue, resulting HLA identical.
However, this treatment was not necessary because after 24 months of follow-up the patient has had a good evolution, with ferritin values and hematopoiesis in normal range.
The patient had good quality of life at 36 months of follow-up.
