Hemophagocytic lymphohistiocytosis (HLH) is a rare hyperinflammatory syndrome characterized by
fever,
pancytopenia and
splenomegaly. The underlying hemophagocytosis occurs primarily in the bone marrow, liver and lymph nodes. Multiple microbiological agents, including cytomegalovirus, Epstein-Barr virus and Mycobacterium tuberculosis, have been implicated in the pathogenesis of HLH. The present study presents a case of HLH associated with Leuconostoc pseudomesenteroides
infection treated successfully with
clindamycin. A 33-year-old man presented with recurrent episodes of
fever and
diarrhea. Upon initial treatment at another hospital (the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China), blood chemistry analysis demonstrated moderate
anemia (
hemoglobin 88 g/l; reference range, 120.0-160.0), elevated
ferritin (1,068.47 mg/l; reference range, 21.81-274.66), total
bilirubin (392.4 mmol/l; reference range, 5.1-28.0), conjugated
bilirubin (335.7 mmol/l; reference range, 0-10.0), and γ-
glutamyl transpeptidase (150 U/l; reference range, 10-60). The patient was treated with
antibiotics for suspected
pneumonia and
cholecystitis, but new symptoms (including
diarrhea and inflammatory
colitis) started to emerge. The patient was subsequently treated with
ganciclovir (5 mg/kg/day for 1 month), but body temperature increased to 41.0°C. Upon transferring to our hospital, the patient had severe
anemia (
hemoglobin, 39 g/l; red blood cell, 1.61×1012/l; reference range, 4.0-5.5×1012/l).
Jaundice was apparent: Total
bilirubin, 299.5 mmol/l; conjugated
bilirubin, 215.7 mmol/l. The patient was treated with
clindamycin (150 mg, taken orally every 12 h for 1 week) and supportive care that included
parenteral nutrition. Symptoms rapidly dissipated after the treatment. Blood chemistry analysis 5 days after the first dose of
clindamycin revealed substantial improvement in
anemia and
jaundice. The patient requested discharge for financial reasons, but continued treatment (details not available) at a local hospital (Pengpai Memorial Hospital, Shanwei, China). Upon a visit to our hospital 8 months later, the patient has no notable complaints, with the exception of moderate
anemia. The present case suggests that HLH may be associated with L. pseudomesenteroides
infection.