A Rare Presentation of Hemophagocytic Lymphohistiocytosis Secondary to Dengue Infection in a Sickle Cell Carrier with Concurrent Hyperhemolysis Syndrome

Abstract

 Hemophagocytic Lymphohistiocytosis (HLH) is a rare but life-threatening hyperinflammatory syndrome that can be triggered by infections, malignancies, and other immune dysregulations. This report discusses the case of a 27-year-old male with sickle cell disease with Beta thalassemia (heterozygous state) who presented with generalized fatigue, weakness, and fever and subsequently developed hemolysis following blood transfusions. A positive IgM dengue test and immunohematology findings, including negative alloantibody screening and negative Direct and Indirect agglutination tests, guided the diagnosis of HLH secondary to dengue infection, with hyperhemolysis syndrome considered a secondary differential. Early recognition of HLH and prompt use of corticosteroids can significantly improve outcomes in complex sickle cell cases with concurrent viral infections.