Secondary haemophagocytic lymphohistiocytosis associated with acute viral hepatitis A – A case series.

This article focuses on hepatitis A virus (HAV)-associated haemophagocytic lymphohistiocytosis (HLH), a rare but severe immune-mediated complication characterized by excessive inflammation and multi-organ dysfunction. The authors present a case series of five adult patients from India with acute HAV infection complicated by secondary HLH, diagnosed using the HLH-2004 criteria, which require meeting at least five of eight clinical and laboratory parameters. Clinical features included persistent high-grade fever after jaundice onset, hepato-splenomegaly, cytopenias, hypertriglyceridemia, and elevated ferritin levels; treatment with corticosteroids led to improvement in most cases, while one patient died before therapy. The report emphasizes the diagnostic challenges due to overlapping symptoms with acute liver failure and the importance of early recognition and immunosuppressive treatment to improve outcomes, noting the need for further research to establish standardized management guidelines.