Abstract

Introduction and purpose: Hemophagocytic lymphohistiocytosis is a condition caused by overactivation of phagocytic cells, leading to destruction of normal blood cells and damage to cells and organ systems, resulting in multi-organ dysfunction, DIC or even death with a very high rate if not diagnosed and treated promptly. We present this clinical case for the purpose of providing additional experience in the diagnosis and treatment of HLH. Case reports: We report a case of a 53-year-old male patient diagnosed 2 months earlier with orchitis, which did not respond to antibiotic and anti-inflammatory therapy; then the patient presented with hemophagocytic syndrome according to HLH-2004 diagnostic criteria with high fever, hepatosplenomegaly, peripheral blood cytopenia, coagulopathy of extrinsic and intrinsic pathway combined with decreased fibrinogen, hyperferritinemia, hypertriglyceridemia and hemophagocytosis in bone marrow. The patient did not respond to antibiotics and developed multi-organ failure and DIC. After that, the patient was treated with high-dose methylprednisolone and therapeutic plasma exchange (TPE), the clinical and paraclinical symptoms gradually improved. Discussion: The patient meets the criteria for HLH diagnosis with an HScore of 309 points and a probability of HLH of up to 99.98%; the cause may be secondary to orchitis. Conclusion: Hemophagocytic syndrome can appear after many different causes with severe clinical consequences, so early diagnosis and treatment are essential for patients. We report that HLH occurs in patients with patients with orchitis that has not been widely reported in previous medical literature