Hemophagocytic syndrome associated with HIV and cytomegalovirus infection

Torres-Salinas C.; Aquino-Sandoval G.; Álvarez G.E.; Paucar K.C.; Quiroz J.M. · Anales de la Facultad de Medicina (2025) · DOI: 10.15381/anales.v86i4.31716

Resumen

Hemophagocytic syndrome (HPS) is a rare and potentially fatal hyperinflammatory disorder caused by dysregulated activation of T lymphocytes and macrophages. We report the case of a 55-year-old man with advanced HIV infection (CD4 count: 14 cells/μL; viral load: 1,770,000 copies/mL) who presented with fever, chronic diarrhea, and pancytopenia. Laboratory findings revealed hypertriglyceridemia, hyperferritinemia, and bone marrow hemophagocytosis. Serology was positive for cytomegalovirus (CMV), establishing the diagnosis of secondary HPS due to HIV and CMV coinfection (HScore: 173). The patient received intravenous ganciclovir, methylprednisolone, and antimicrobial prophylaxis, showing transient improvement but later developed refractory pancytopenia and died. This case highlights the complex immunopathological interaction between HIV and CMV, emphasizing the need for early diagnosis and standardized therapeutic strategies in immunocompromised patientsHemophagocytic syndrome (HPS) is a rare and potentially fatal hyperinflammatory disorder caused by dysregulated activation of T lymphocytes and macrophages. We report the case of a 55-year-old man with advanced HIV infection (CD4 count: 14 cells/μL; viral load: 1,770,000 copies/mL) who presented with fever, chronic diarrhea, and pancytopenia. Laboratory findings revealed hypertriglyceridemia, hyperferritinemia, and bone marrow hemophagocytosis. Serology was positive for cytomegalovirus (CMV), establishing the diagnosis of secondary HPS due to HIV and CMV coinfection (HScore: 173). The patient received intravenous ganciclovir, methylprednisolone, and antimicrobial prophylaxis, showing transient improvement but later developed refractory pancytopenia and died. This case highlights the complex immunopathological interaction between HIV and CMV, emphasizing the need for early diagnosis and standardized therapeutic strategies in immunocompromised patients. © (2024), (). All Rights Reserved.

Instituciones: Universidad Nacional de la Amazonía Peruana; Universidad Continental