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Case Reports
. 2020 Mar 9;11(2):219-221.
doi: 10.4103/idoj.IDOJ_299_19. eCollection 2020 Mar-Apr.

Hemophagocytic Lymphohistiocytosis Complicating Methotrexate Toxicity

V T Anjali  1 , Reena Rai  1 , G Uma Maheswari  2 , Prasanna N Kumar  2
Affiliations
Case Reports

Hemophagocytic Lymphohistiocytosis Complicating Methotrexate Toxicity

V T Anjali et al. Indian Dermatol Online J. .

Abstract

Hemophagocytic syndrome or hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal disease caused by dysregulated activation of macrophages against one's blood cells. Major pathologic feature of HLH is hemophagocytosis. We present a case of HLH complicating methotrexate toxicity in a 65-year-old psoriatic patient with history of renal disease. Diagnosis of HLH was established as he fulfilled five out of eight HLH diagnostic criteria. This case report is presented to enlighten clinicians about the clinical entity of HLH and to suspect and recognize this rare and generally fatal disease at the earliest.

Keywords: Cytopenias; hemophagocytic lymphohistiocytosis; hemophagocytic syndrome.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Skin with detached stratum corneum, large subcorneal pustule (H and E, ×4). (b) Mild spongiosis, marked regenerative atypia, basal vacuolar degeneration, pigment incontinence and apoptotic keratinocytes (H and E, ×40)
Figure 2
Figure 2
Peripheral smear showing pancytopenia (Giemsa ×40)
Figure 3
Figure 3
Bone marrow showing hemophagocytosis. (a) Giemsa ×40. (b) Oil immersion ×100)
See this image and copyright information in PMC

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