Abstract: SA-PO1023
Hemophagocytic Lymphohistiocytosis Due to Disseminated Toxoplasmosis in a Kidney Transplant Patient
Session Information
- Transplantation: Clinical - Case Reports
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Ukponmwan, Esosa Uwaifo, Kaiser Permanente San Francisco Medical Center, San Francisco, California, United States
- Sandhu, Rana, Kaiser Permanente San Francisco Medical Center, San Francisco, California, United States
- Bhalla, Anshul, Kaiser Permanente San Francisco Medical Center, San Francisco, California, United States
- Lapasia, Jessica B., Kaiser Permanente San Francisco Medical Center, San Francisco, California, United States
- Zheng, Sijie, The Permanente Medical Group Inc, Oakland, California, United States
Introduction
Hemophagocytic lymphohistiocytosis (HLH) is a rare serious medical disorder characterized by uncontrolled activation of the immune system leading to a cytokine storm. Triggers include genetic activation, infection, immunosuppression or neoplasm. We report a case of HLH triggered by Toxoplasmosis in a kidney transplant patient.
Case Description
A 42 year-old man with a history of ESKD due to ADPKD status-post deceased donor kidney transplant 8 months prior. He had a one-week history of fatigue, malaise, fever, decreased appetite, nausea, vomiting, diarrhea, frontal and bilateral maxillary headaches.
Laboratory showed a normal CBC and metabolic panel. Creatinine 1.97mg/dl (baseline 1.2mg/dl), infectious panel, blood cultures and viral panels were negative. He was started on antibiotics and hemodialysis.
On day 9, he developed multiorgan dysfunction with septic shock, requiring ventilator and vasopressor support. Antibiotics were broadened.
On day 10, ferritin level was 108,329ng/ml. Cerebrospinal fluid and bronchoalveolar lavage were positive for Toxoplasma gondii. Bone marrow biopsy revealed hemophagocytes.
He was diagnosed with hemophagocytic lymphohistiocytosis due to disseminated Toxoplasmosis.
He received HLH-94 protocol with Intravenous Etoposide and Dexamethasone. Toxoplasmosis was managed with Sulfadiazine, Pyrimethamine and Leucovorin. Clinical symptoms improved and allograft renal function recovered, he was discharged on Day 26.
Discussion
HLH is associated with high mortality, it requires a high index of suspicion and aggressive management. It mimics sepsis and hematologic malignancies. HLH can be Primary in children or Secondary when caused by infections, malignancies, rheumatologic disorders and drug hypersensitivities.
In acquired HLH due to infections, immunologic causes or malignancies, management also involves aggressively treating the underlying cause.
Relapse is common, hence close follow up is needed at time of discharge.
Hemophagocytes on bone marrow biopsy (H&E stain)