Secondary hemophagocytic lymphohistiocytosis to disseminated histoplasmosis in the setting of chronic immunosuppression

This case report illustrates the effective management of disseminated histoplasmosis-induced secondary hemophagocytic lymphohistiocytosis using intravenous liposomal amphotericin B and prednisone in a patient undergoing long-term treatment for rheumatoid arthritis with immunosuppressive medications. A 57-year-old immunocompromised male presented with fevers, chills, myalgias, and pancytopenia. He received a diagnosis of disseminated histoplasmosis and met criteria for secondary hemophagocytic lymphohistiocytosis. Treatment with intravenous liposomal amphotericin B and prednisone proved successful. Following significant clinical improvement within two weeks, he transitioned to oral itraconazole with plans for a twelve-month continuation. Many uncertainties remain regarding the optimal management of secondary hemophagocytic lymphohistiocytosis in the context of disseminated histoplasmosis, particularly regarding the utilization of immunosuppressive therapy and intravenous immunoglobulin. Currently, the decision to employ immunosuppression should be tailored to each patient’s unique clinical scenario.