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Introduction <p>Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening hyperinflammatory syndrome characterized by uncontrolled activation of immune cells, resulting in cytokine storm and multi-organ dysfunction. While viral infections are the most common triggers, bacterial pathogens such as <i>Klebsiella pneumoniae</i> are increasingly recognized as uncommon causes of secondary HLH.</p> Case Presentation <p>We present the case of a 74-year-old male with a history of diabetes mellitus and chronic obstructive pulmonary disease (COPD), who was admitted with high-grade fever, hemoptysis, and respiratory distress. Imaging revealed necrotizing pneumonia in the right upper lobe. Microbiological analysis of sputum and bronchoalveolar lavage (BAL) samples confirmed <i>Klebsiella pneumoniae</i>. Laboratory investigations showed pancytopenia, elevated ferritin levels, and splenomegaly. A bone marrow biopsy demonstrated hemophagocytosis. A diagnosis of HLH was made based on HLH-2004 criteria. The patient was managed conservatively with intravenous antibiotics, blood component transfusions, and supportive care, without the use of immunosuppressive therapy. He showed significant clinical improvement.</p> Conclusions <p><i>Klebsiella pneumoniae</i> can act as a rare trigger for secondary HLH. In selected cases, especially where the underlying infection is adequately addressed, targeted antimicrobial therapy combined with supportive care may suffice. Early recognition and diligent monitoring are critical to improving outcomes in such cases.</p>

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Unmasking Hemophagocytic Lymphohistiocytosis and a Management Dilemma in a Case of Necrotizing Klebsiella Pneumonia – A Case Report

  • 期刊论文

  • 发表日期：

    2025年10月25日

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  • Neeraj Sharma,
  • Robin Choudhary,
  • Kushal Sharma,
  • Kavita Sinha,
  • Shipra Verma

摘要

Introduction

Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening hyperinflammatory syndrome characterized by uncontrolled activation of immune cells, resulting in cytokine storm and multi-organ dysfunction. While viral infections are the most common triggers, bacterial pathogens such as Klebsiella pneumoniae are increasingly recognized as uncommon causes of secondary HLH.

Case Presentation

We present the case of a 74-year-old male with a history of diabetes mellitus and chronic obstructive pulmonary disease (COPD), who was admitted with high-grade fever, hemoptysis, and respiratory distress. Imaging revealed necrotizing pneumonia in the right upper lobe. Microbiological analysis of sputum and bronchoalveolar lavage (BAL) samples confirmed Klebsiella pneumoniae. Laboratory investigations showed pancytopenia, elevated ferritin levels, and splenomegaly. A bone marrow biopsy demonstrated hemophagocytosis. A diagnosis of HLH was made based on HLH-2004 criteria. The patient was managed conservatively with intravenous antibiotics, blood component transfusions, and supportive care, without the use of immunosuppressive therapy. He showed significant clinical improvement.

Conclusions

Klebsiella pneumoniae can act as a rare trigger for secondary HLH. In selected cases, especially where the underlying infection is adequately addressed, targeted antimicrobial therapy combined with supportive care may suffice. Early recognition and diligent monitoring are critical to improving outcomes in such cases.