Title : Sepsis or HLH? Solving the diagnostic puzzle in multiorgan failure
Abstract:
Sepsis and Hemophagocytic Lymphohistiocytosis (HLH) are two critical and life-threatening conditions that often share overlapping clinical features, leading to diagnostic challenges. However, their underlying pathophysiology and treatment approaches differ significantly, making accurate differentiation crucial.
Sepsis is an immune dysregulation syndrome triggered by infection, characterized by a systemic inflammatory response that can progress to multiple organ dysfunction. In contrast, HLH is a severe immune system disorder marked by abnormal activation of immune cells and a cytokine storm, leading to multiorgan failure.
This presentation will explore the diagnostic process through a shared case study of a patient admitted with fever and multiorgan dysfunction. Initially suspected of sepsis, the clinical course and investigations pointed towards HLH. Key diagnostic indicators such as persistent fever, hepatosplenomegaly, cytopenias, hyperferritinemia, hypertriglyceridemia, and hypofibrinogenemia were instrumental in differentiating HLH. Additional confirmation came from bone marrow examination, which revealed hemophagocytosis.
Through this case, we will delve into the critical differences in clinical features, laboratory findings, diagnostic criteria (e.g., HLH-2004 criteria), and therapeutic strategies between sepsis and HLH. By highlighting the nuances in their pathophysiology and management, this presentation aims to provide clinicians with practical guidance on distinguishing between these conditions, thereby improving diagnostic accuracy and treatment outcomes.
