HYPERFERRITINEMIA IN REACTIVE HEMOPHAGOCYTIC SYNDROME REPORT OF 4 ADULT CASES

Four patients were diagnosed with reactive hemophagocytic syndrome (RH PS) during a 7 month period. Of these, three patients were diagnosed w ith acquired immunodeficiency syndrome complicated by disseminated Myc obacterium tuberculosis infection, incompletely treated Pneumocystis c arinii pneumonia and disseminated histoplasmosis respectively. The fou rth patient had non-Hodgkin's lymphoma of the mature T-cell phenotype. Fever, bicytopenia, or pancytopenia, elevated serum lactate dehydroge nase (LDH) level (>1,000 IU/L), and hemophagocytic histiocytosis in sm ears of bone marrow aspirate were present in all patients. Hyperferrit inemia (>10,000 ng/ml) was present in all (range 34,976 to 425,984 ng/ mL) and showed a decrease in the two patients who responded to therapy . Hyperferritinemia (>10,000 ng/ml) and elevated serum LDH (>1,000 IU/ L) are important clues to the diagnosis of RHPS in the febrile cytopen ic patient with immunodeficiency. (C) 1995 Wiley-Liss, Inc.