[A case of hepatitis-associated aplastic anemia complicated by hemophagocytic lymphohistiocytosis and literature review]

Abstract

A 4-year-old boy was admitted to the hospital with a 3-day history of rash and intermittent abdominal pain, during which abnormal results from routine blood tests were discovered. Initially, he presented with acute jaundice hepatitis and pancytopenia. The patient's condition progressed rapidly, with recurrent fever, worsening jaundice of the skin and sclera, and progressively worsening hepatosplenomegaly. Liver function impairment and bone marrow failure continued to deteriorate, while cytokine levels continued to rise. After excluding infections, autoimmune diseases, tumors, genetic metabolic disorders, and toxicities, the patient was diagnosed with hepatitis-associated aplastic anemia (HAAA) complicated by hemophagocytic lymphohistiocytosis (HLH). Following treatment with corticosteroids, plasma exchange, intravenous immunoglobulin, and liver protection therapy, the patient's symptoms partially alleviated. Aplastic anemia complicated by HLH is relatively uncommon, and HAAA complicated by HLH is even rarer, often presenting insidiously and severely. This paper presents a case of HAAA complicated by HLH and summarizes previously reported cases in the literature, providing references for the early diagnosis and treatment of this condition.

Keywords: Child; Hemophagocytic lymphohistiocytosis; Hepatitis-associated aplastic anemia.

图1. 骨髓检查 A（骨髓细胞学，入院第1天，右侧髂后上棘，苏木精-伊红染色，10×40）：骨髓增生活跃，全片非造血细胞如组织细胞增多。B（骨髓细胞学，入院第6天，左侧髂前上棘，苏木精-伊红染色，10×40）：骨髓增生低下，全片巨核细胞和血小板未见，非造血细胞增多。C（骨髓活检，入院第6天，左侧髂前上棘，苏木精-伊红染色，10×40）：骨髓增生极度低下改变，脂肪组织增生，少量淋巴细胞、浆细胞散在可见，未见纤维化。

图2. 腹部CT：平扫+增强结果 A：肝门区肿大淋巴结（箭头所指）；B：胆囊壁明显水肿（箭头所指）。