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Hemophagocytic lymphohistiocytosis (HLH) is a rare and fatal complication of visceral leishmaniasis (VL). To provide a basis for early and correct diagnosis and to improve prognosis in the future, we describe a case series of VL-associated HLH in adults in our center in the past decade after review of all reported cases of adult VL-associated HLH in English through May 2022. In our case series, a total of 111 patients were diagnosed with VL. Among these patients, only six cases were diagnosed with VL-associated HLH. All patients tested positive for serology. Leishmania was detected for the first time by bone marrow aspiration (BMA) in three of the six patients and in the other three patients after three or four BMAs. It took more than 1 month from onset to diagnosis of VL for all the six cases, and the longest time was 6 months. Five of the six patients recovered after receiving sodium stibogluconate. VL-associated HLH is rare but potentially life-threatening in adults and predisposes to early delays in diagnosis. However, diagnostic techniques are not complicated or difficult, so it is more important to consider that it is not recognized by physicians. Although guidelines recommend liposomal amphotericin B as the most effective therapy, our experience suggests that sodium stibogluconate can be an alternative option when liposomal amphotericin B is unavailable or unaffordable.
Financial support: The study was supported by a grant from the Key Research and Development Project, Science and Technology Project of Sichuan Province, China (No. 2019YFS0202 to F. H.).
Disclosure: The views in this article are those of the authors and not of their institutions.
Authors’ addresses: Yao Qin, Xiaoju Lv, and Fang He, Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China, E-mails: qinyao0327@163.com, lvxj33966@126.com, and fanghe923@hotmail.com. Yao Qin and Ting Liu, Department of Hematology, West China Hospital, Sichuan University, Chengdu, China, E-mails: qinyao0327@163.com and liuting_57@163.com. Qin Zheng and Mei Kang, Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China, E-mails: zhengqin1016@126.com and Kangmei@sina.com. Qian Wu and Linmao Zheng, Department of Pathology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China, E-mails: 540740249@qq.com and 18842628348@163.com.