Hemophagocytic Lymphohistiocytosis Secondary to Melioidosis in Paediatric Patients: A Case Series

Kecheng Wan,* Yingjie Liu,* Yuwen Chen, Song Sun, Hong Liang Department of Paediatrics, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hong Liang, Department of paediatrics, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua Road, Xiuying District, Haikou, Hainan Province, 570311, People’s Republic of China, Tel +86 898963399, Email [email protected]: Melioidosis caused by Burkholderia pseudomallei manifests as a variety of infectious symptoms. However, hemophagocytic lymphohistiocytosis (HLH) secondary to bacteraemic melioidosis is rarely documented in the literature. We report a series of fatal cases of melioidosis combined with HLH in one Chinese family.Case Presentation: Three cases of melioidosis with HLH were reported in a family with three children, two boys aged 4 and 6 years and a 12-year-old girl. The most common clinical presentation was fever. A blood culture confirmed B. pseudomallei, and bone marrow aspiration revealed hemophagocytosis. Despite the administration of antibiotics, glucocorticoids and other treatments, all the patients died, and their deaths were attributed to HLH.Conclusion: Melioidosis complicating HLH is rare in occurrence, but the mortality rate is high. Clinicians should be aware of the risk of a B. pseudomallei bloodstream infection in children.Keywords: melioidosis, Burkholderia pseudomallei, hemophagocytic lymphohistiocytosis, family