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Hemophagocytic lymphohistiocytosis in kidney transplantation: a call for heightened vigilance

Year: 2025

Type: article

Abstract: Hemophagocytic lymphohistiocytosis is a rare, severe, and potentially fatal disease, mainly encountered in individuals with immunologic diseases. Early diagnosis and prompt intervention may be life-saving. Herein, we report a case of a 52-year-old man who had undergone kidney transplantation nine years previously, presenting with persistent fever of unknown origin and graft function impairment. Despite receiving broad-spectrum antimicrobials and undergoing an exhaustive work-up for infectious, autoimmune, and oncologic diseases, he developed pancytopenia, hepatosplenomegaly, and respiratory failure. A bone marrow biopsy revealed florid hemophagocytosis, hyperferritinemia, hypertriglyceridemia, elevated serum soluble CD25, and cytopenia. These findings fulfilled seven of the Hemophagocytic lymphohistiocytosis 2004 criteria. High dose dexamethasone induced a partial, transitory response and lowered the fever, but multiorgan failure progressed, and the patient died three weeks after ICU admission. This case underscores that hemophagocytic lymphohistiocytosis should be considered whenever kidney transplant recipients develop unexplained fever, cytopenia, and hyperferritinemia, and suggests that early bone marrow evaluation with targeted immunomodulation may improve outcomes in this vulnerable population.

Source: Journal of Nephrology

DOI: 10.1007/s40620-025-02446-8

Authors: Ahmed Mansour Abdel-Rahman, Muhammed Ahmed Elhadedy, Donia Elsaed Gad, Sara Elsherbini, Ayman F. Refaie

Institution: Mansoura University

Language: English

Topic: Autoimmune and Inflammatory Disorders Research

Subfield: Hematology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,337