Abstract
RATIONALE: Hemophagocytic lymphohistiocytosis (HLH) is a rare, potentially fatal multisystem inflammatory disorder with nonspecific clinical manifestations. Early diagnosis of this condition is inherently challenging. Here, this study reports a case of hemophagocytic lymphohistiocytosis associated with Epstein-Barr virus (EBV) infection with giant axillary lymph nodes. PATIENT CONCERNS: A 50-year-old woman presented with HLH who presented with fever and shock, followed by rapid impairment of liver and coagulation function, accompanied by giant lymph nodes in the right axilla. DIAGNOSES: Bone marrow examination revealed no abnormality. Epstein-Barr virus load of nucleic acid in peripheral blood was 1.65 × 106 copies/mL. The number of EBV sequences detected by high-throughput sequencing was 543, which confirmed EBV infection. INTERVENTIONS: We treat patients with symptomatic and supportive care. OUTCOMES: The patient responded to symptomatic and supportive treatment and was discharged. At 2-month follow-up, the patient had no complaints, and the EBV load of nucleic acid was <500 copies/mL. LESSONS: In patients presenting with fever and shock followed by rapid impairment of liver function and coagulation function, and enlarged axillary lymph nodes, the possibility of EBV-HLH should be considered. Early identification and initiation of etiologic treatments for EBV-HLH are pivotal for good prognosis of patients.