Disseminated histoplasmosis induced hemophagocytic lymphohistiocytosis in an immunocompromised patient

• Disseminated histoplasmosis induced HLH is a severe disorder. • Immunotherapy may worsen the underlying infection in secondary HLH. • Evidence for the use of etoposide in adults with HLH is scarce. • This is a first case of the use of anakinra in histoplasmosis induced HLH. • HLH treatment should be tailored to the condition of the patient. The search for the trigger of hemophagocytic lymphohistiocytosis (HLH) and its management can be challenging in immunocompromised patients. In HLH triggered by infection, immunosuppressive therapy is desired to suppress hyperinflammation, but may worsen the underlying infection. To review available literature on the management and prognosis of immunocompromised patients with disseminated histoplasmosis induced HLH. We describe a case and review all previously reported cases of disseminated histoplasmosis induced HLH on PubMed until June 2023. The literature review yielded 30 cases. Antifungal therapy was administered in all except one patient. In 18 cases, HLH was treated with immunosuppressive therapy. The most common immunosuppressive regimens were corticosteroid monotherapy and corticosteroids combined with etoposide. This case report is the first to describe the use of anakinra. The overall mortality rate was 23.3 % (n = 7). Disseminated histoplasmosis induced HLH is a severe disorder, requiring prompt recognition and immediate intervention. Currently, no specific treatment protocol exists for this disorder. Treatment should be tailored to the patient’s condition, symptoms and individual characteristics. Careful consideration regarding immunosuppressive therapy for HLH is needed to prevent worsening of the infection. Additionally, anticipating the progression of the disease is necessary to ensure timely and appropriate interventions.