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- antigen retrieval
- bone marrow trephines
- gynaecological pathology
- lymph nodes
- molecular pathology
Haemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome sustained by extreme immunological activation and associated with specific symptoms and pathological findings (box 1).1–3
Diagnostic criteria for HLH. The diagnosis of HLH can be established if one of either A or B below is fulfilled
A. A molecular diagnosis consistent with HLH: pathological mutations in PRF1, MUNC13-4, MUNC 18-2, Rab27a, STX11, SH2D1A, or BIRCA.
B. Diagnostic criteria for HLH fulfilled (five out of the eight criteria listed below):
Cytopenias (affecting at least two of three lineages in the peripheral blood):
Haemoglobin <90 g/l (in infants <4 weeks: haemoglobin <100 g/l)
Hypertriglyceridemia (fasting, >3.0 mmol/l) and/or hypofibrinogenemia (<1.5 g/l)
Haemophagocytosis in bone marrow, spleen lymph nodes, or liver
Low or absent natural killer cell activity
Ferritin >500 μg/l
sCD25 >24×103 U/l
Adapted from Henter et al,1 according to Jordan et al2
First described in 1952 as a familial syndrome,4 HLH is now regarded both as a primary and a secondary disease, triggered by various neoplastic and non-neoplastic disorders. Primary HLH are caused by specific mutations in genes involved in the cytotoxic immune response: up to 30% of cases are linked to MUNC13-4 loss, which leads to familial haemophagocytic lymphohistiocytosis type 3 (FHL3).2
We report the unique case of a monoclonal plasma cell disorder that arose in a patient with FHL3. To our knowledge, such an association has never been reported …
Competing interests None.
Patient consent Obtained.
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