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Disseminated infection to immune activation.
A 61-year-old woman with rheumatoid arthritis on chronic immunosuppression presented with fever. Laboratory studies demonstrated multiorgan failure with pancytopenia, elevation in liver function studies, and an elevated ferritin level, with a diagnosis of hemophagocytic lymphohistiocytosis confirmed on bone marrow biopsy. After initial treatment with chemotherapy, fungal blood cultures grew Histoplasma , prompting initiation of antifungal therapy, which resulted in successful treatment of Histoplasma -associated hemophagocytic lymphohistiocytosis.
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