The clinical and autopsy findings in a case of virus-associated hemophagocytic syndrome in a previously healthy 17-year-old girl are presented. Serum titers to Epstein-Barr viral antigens were unusually elevated. In addition to widespread proliferation of hemophagocytic histiocytes and lymphoid depletion, there were areas of non-suppurative necrosis in lymph nodes and spleen, which have not been previously reported.