Cytomegalovirus-related hemophagocytosis in childhood acute lymphoblastic leukemia

Abstract

This letter describes a case of cytomegalovirus (CMV)-associated hemophagocytic lymphohistiocytosis (HLH) in a 33-month-old girl undergoing maintenance therapy for precursor B-cell acute lymphoblastic leukemia. The patient presented with fever, splenomegaly, pancytopenia, hyperferritinemia, and CMV reactivation, while bone marrow examination confirmed hemophagocytosis without leukemia relapse. She was successfully treated with the HLH-2004 protocol combined with antiviral therapy and intravenous immunoglobulin, resulting in rapid clinical improvement, normalization of laboratory findings, and resumption of leukemia maintenance therapy. At one-year follow-up, the patient remained in remission with no recurrence of HLH or CMV infection. The report emphasizes that HLH should be considered in immunosuppressed pediatric leukemia patients presenting with prolonged fever and cytopenia, as early recognition and treatment are essential for favorable outcomes.