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Peer-reviewedCC BY-NC-NDMycoses

Clinical Impact of Haemophagocytic Lymphohistiocytosis Among Patients With HIV/AIDS and Disseminated Histoplasmosis in a Hyperendemic Region of Northeastern Brazil

  • Matheus Alves de Lima Mota1,2
  • Marcos Maciel Sousa2
  • João Victor Monteiro Souza3
  • Italo Oliveira Moura3
  • Jéssica Maria de Sousa Oliveira3
  • Jacó Ricarte Lima de Mesquita2
  • Lisandra Serra Damasceno2,4
  • Terezinha do Menino Jesus Silva Leitão2,4
  • Gdayllon Cavalcante Meneses5
  • Elizabeth De Francesco Daher1
5 affiliations
  1. 1Medical Sciences Post-Graduate Program, Department of Internal Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
  2. 2São José Hospital of Infectious Diseases, Fortaleza, Ceará, Brazil.
  3. 3Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
  4. 4Department of Community Health, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
  5. 5Department of Clinical and Toxicological Analyses, Federal University of Ceará, Fortaleza, Ceará, Brazil.
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Abstract

Background

Haemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome that may occur in people living with HIV/AIDS (PLWHA), often triggered by opportunistic infections such as disseminated histoplasmosis (DH). The substantial overlap in clinical and laboratory features between HLH and DH complicates timely diagnosis.Objectives

To describe HLH among PLWHA with DH and compare clinical, laboratory and outcome characteristics between patients with and without HLH.Patients/methods

A retrospective observational study was conducted at São José Hospital of Infectious Diseases, Fortaleza, Brazil, between March 2023 and June 2024. Hospitalised PLWHA with DH were evaluated for HLH based on the presence of ≥ 3 HLH-2004 criteria and an H-Score ≥ 169. Baseline clinical, laboratory and outcome parameters were compared between patients with and without HLH.Results

Among 61 patients diagnosed with DH, 11 (18.0%) met the study criteria for HLH. Patients with HLH were more likely to present with hepatomegaly (p = 0.036), haemoptysis (p = 0.030) and lower platelet counts (p = 0.029). In-hospital mortality was significantly higher among patients with HLH (54.5% versus 18.0%; p = 0.019). These patients more frequently required renal replacement therapy (p = 0.028) and intensive care unit admission (p = 0.048). Kaplan-Meier analysis with log-rank testing demonstrated significantly reduced in-hospital survival among patients with HLH (p = 0.015).Conclusions

HLH represents a severe complication in PLWHA with DH and is associated with increased mortality and greater need for intensive care. Early recognition and use of adjunctive diagnostic tools may facilitate timely management and improve clinical outcomes.

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Cite

BibTeXRIS
BibTeX
@article{mota2026clinical,
  title = {{Clinical Impact of Haemophagocytic Lymphohistiocytosis Among Patients With HIV/AIDS and Disseminated Histoplasmosis in a Hyperendemic Region of Northeastern Brazil}},
  author = {Matheus Alves de Lima Mota and Marcos Maciel Sousa and João Victor Monteiro Souza and Italo Oliveira Moura and Jéssica Maria de Sousa Oliveira and Jacó Ricarte Lima de Mesquita and Lisandra Serra Damasceno and Terezinha do Menino Jesus Silva Leitão and Gdayllon Cavalcante Meneses and Elizabeth De Francesco Daher},
  journal = {Mycoses},
  year = {2026},
  month = oct,
  doi = {10.1111/myc.70194},
  url = {https://europepmc.org/article/PMC/PMC13717469},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Clinical Impact of Haemophagocytic Lymphohistiocytosis Among Patients With HIV/AIDS and Disseminated Histoplasmosis in a Hyperendemic Region of Northeastern Brazil
AU  - Matheus Alves de Lima Mota
AU  - Marcos Maciel Sousa
AU  - João Victor Monteiro Souza
AU  - Italo Oliveira Moura
AU  - Jéssica Maria de Sousa Oliveira
AU  - Jacó Ricarte Lima de Mesquita
AU  - Lisandra Serra Damasceno
AU  - Terezinha do Menino Jesus Silva Leitão
AU  - Gdayllon Cavalcante Meneses
AU  - Elizabeth De Francesco Daher
PY  - 2026
DA  - 2026/10/29
JO  - Mycoses
DO  - 10.1111/myc.70194
UR  - https://europepmc.org/article/PMC/PMC13717469
AB  - Background  Haemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome that may occur in people living with HIV/AIDS (PLWHA), often triggered by opportunistic infections such as disseminated histoplasmosis (DH). The substantial overlap in clinical and laboratory features between HLH and DH complicates timely diagnosis.Objectives  To describe HLH among PLWHA with DH and compare clinical, laboratory and outcome characteristics between patients with and without HLH.Patients/methods  A retrospective observational study was conducted at São José Hospital of Infectious Diseases, Fortaleza, Brazil, between March 2023 and June 2024. Hospitalised PLWHA with DH were evaluated for HLH based on the presence of ≥ 3 HLH-2004 criteria and an H-Score ≥ 169. Baseline clinical, laboratory and outcome parameters were compared between patients with and without HLH.Results  Among 61 patients diagnosed with DH, 11 (18.0%) met the study criteria for HLH. Patients with HLH were more likely to present with hepatomegaly (p = 0.036), haemoptysis (p = 0.030) and lower platelet counts (p = 0.029). In-hospital mortality was significantly higher among patients with HLH (54.5% versus 18.0%; p = 0.019). These patients more frequently required renal replacement therapy (p = 0.028) and intensive care unit admission (p = 0.048). Kaplan-Meier analysis with log-rank testing demonstrated significantly reduced in-hospital survival among patients with HLH (p = 0.015).Conclusions  HLH represents a severe complication in PLWHA with DH and is associated with increased mortality and greater need for intensive care. Early recognition and use of adjunctive diagnostic tools may facilitate timely management and improve clinical outcomes.
SN  - 0933-7407
SN  - 1439-0507
ER  -