death from hemophagocytic lymphohistiocytosis syndrome due to generalized hemorrhage

Hemophagocytic lymphohistiocytosis (hlh) is the result of excessive cytokine release, leading to over-response by immune cells, such as macrophages and t lymphocytes. here, we report a lethal case of hlh with a complete clinical course. the patient was a 45-year-old man with fever and chills since two months ago plus splenomegaly, hepatomegaly, and pancytopenia. the anti-hbc igm was positive, but the hbs antigen, anti-hcv, and hbs antibody were negative. assessment for cirrhosis was carried out by fibroscan, which showed f4 grade. the biopsy sampling was impossible due to the low platelet count. during admission, generalized bleeding was developed and led to alveolar hemorrhage, which subsequently resulted in the patient's death. liver necropsy certified the diagnosis of hemophagocytic syndrome. overall, according to the reported case in this paper, it should be remembered that secondary hlh is an inflammatory phenomenon due to different conditions, such as latent newly-developed infections.