Haemophagocytic lymphohistiocytosis (HLH) with concurrent Hodgkin’s Disease

Haemophagocytic lymphohistiocytosis (HLH) is a condition of uncontrolled immune activation caused by genetic defects or triggered by infections, malignancies, autoimmune diseases, drugs, pregnancy or post-transplant immunosuppression. This case describes a young man presenting with clinical jaundice and abnormal blood tests, including raised inflammatory markers, abnormal liver function, low haemoglobin (65 g/L) and a low white blood cell count (3.08×10⁹/L). He met five out of eight HLH criteria and tested positive for Epstein-Barr virus (EBV) PCR (58 011 IU/mL). His bone marrow biopsy showed EBV-driven Hodgkin's lymphoma. He was initially treated with the HLH-94 protocol and later switched to ABVD chemotherapy (adriamycin, bleomycin, vinblastine and dacarbazine). He steadily recovered despite a prolonged hospital stay. He was discharged to complete his remaining cycles of chemotherapy as an outpatient with a plan of having a positron emission tomography (PET) scan after two cycles of chemotherapy.