case_images: PMC9664932_01
case_images: Patient Laboratory and Clinical Response based on HLH-2004 Clinical Criteria and Hscore. X indicates that a criterion was met.
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case_images: HLH was considered according to the symptoms displayed by the patient and the results of examination (Figure 1). HLH-directed therapy was initiated with methylprednisolone (10 mg/kg per day) and etoposide (100 mg/m2). Before long, he exhibited pancytopenia, high serum ferritin, low NK-cell activity, high sCD25, splenomegaly, and hemophagocytosis in bone marrow (Figure 1).
case_images: Bone marrow aspirate showed Leishman-Donovan bodies and hemophagocytosis. Wright's staining, x100 oil immersion lens.
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case_images: Bone marrow aspirate showed Leishman-Donovan bodies (Figure 2), and Leishmania infantum Noicolle DNA was detected in bone marrow.
case_images: Clinical and laboratory findings. (A) Temperature curve ( C). The patient was afebrile after HLH-1994 regimen treatment. The patient developed fever again during dexamethasone reduction. The patient became afebrile and remained so after Ruxolitinib and Amphotericin B were administered. (B-D) WBC, HB, and PLT counts. WBC, HB, and PLT recovered after the HLH-1994 regimen. After treatment based on Ruxolitinib and Amphotericin B, WBC, HB, and PLT counts returned to the normal levels. (E-G) sCD25, ferritin and cytokines curves. After treatment based on Ruxolitinib and Amphotericin B, sCD25, ferritin and cytokines were reduced to normal.
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case_images: During a follow-up made in October 2020, the patient was treated with Ruxolitinib, and the results of laboratory examinations were normal (Figure 3).