case_images: PMC8325589_01
case_images: Hematoxylin and eosin (H&E) section of the hypocellular bone marrow with no definitive infiltration by lymphoma.
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case_images: PMC8325589_01_CRIHEM2021-6672257.001.jpg
case_images: fig1
case_images: A bone marrow biopsy was performed and did not show phagocytic histiocytes or evidence of malignancy (Figure 1).
case_images: PET scan revealing the hypermetabolic focus localized to the left palatine tonsil.
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case_images: PMC8325589_01_CRIHEM2021-6672257.002.jpg
case_images: fig2
case_images: In the interim, he underwent a positron emission tomography (PET) scan which revealed a hypermetabolic focus in the left palatine tonsil (Figure 2).
case_images: H&E section of the bone marrow revealing hemophagocytosis (a). High-powered H&E section (b) and chloracetate esterase section (c) demonstrating binucleated Reed-Sternberg (RS) cells. Immunohistochemistry showed positivity for CD30 (d) and CD15 (e) in RS cells. Epstein-Barr encoding region in situ hybridization (EBER-ISH) (f).
case_images: CRIHEM2021-6672257.003.jpg
case_images: PMC8325589_01_CRIHEM2021-6672257.003.jpg
case_images: fig3
case_images: The patient underwent repeat bone marrow biopsy which showed Hodgkin lymphoma with hemophagocytic lymphohistiocytosis (Figure 3), confirming the diagnosis of HLH.