ArticleCureus2026
Haemophagocytic Lymphohistiocytosis Triggered by Visceral Leishmaniasis Masquerading as Epstein-Barr Virus (EBV)-Associated Haemophagocytic Lymphohistiocytosis in Rheumatoid Arthritis: A Case Report and Literature Review.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Haemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome caused by uncontrolled immune activation. In adults, it is usually secondary to an underlying condition, such as infection, malignancy, or autoimmune disease. Identifying this trigger is essential, as treatment depends on the cause. Visceral leishmaniasis (VL) is a systemic parasitic infection that may mimic or trigger HLH, particularly in immunosuppressed patients. We report a 59-year-old man with seropositive rheumatoid arthritis, for which he received immunosuppressive treatment with methotrexate and etanercept. For eosinophilic asthma, he was treated with benralizumab. Four months after travelling to the Valencia region in Spain, the patient presented with high fever, marked splenomegaly and pancytopenia. Further laboratory findings showed progressive hyperferritinaemia, hypofibrinogenaemia, and hypertriglyceridaemia, together with haemophagocytosis on bone marrow examination, which supported the diagnosis of secondary HLH. Because Epstein-Barr virus (EBV) DNA was detected in peripheral blood, EBV-associated HLH was initially suspected, and treatment was started with rituximab, targeting potentially EBV-infected B cells, and dexamethasone to suppress the hyperinflammatory response. Further infectious work-up, however, revealed a strongly positive
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