Fatal haemophagocytic lymphohistiocytosis and atypical haemolytic uraemic syndrome following coronavirus disease 2019 infection.

Authors

Jennifer Khong, Alisa Liberman, Arabella Hammoudeh, Karthik Kailasam

Published in

BMJ case reports. Volume 19. Issue 10. Oct 07, 2026. Epub Oct 07, 2026.

Abstract

A previously healthy woman in her early 30s developed rash, fever and arthralgia 3 weeks after SARS-CoV-2 infection, rapidly progressing to multiorgan failure. Laboratory studies revealed severe thrombocytopenia (23×10⁹/L), microangiopathic haemolytic anaemia, acute kidney injury and ferritin >100 000 ng/mL. Kidney biopsy demonstrated thrombotic microangiopathy with negative antinuclear antibody, supporting atypical haemolytic uraemic syndrome (aHUS). Concurrently, low haptoglobin, elevated lactate dehydrogenase (2500 U/L), interleukin-2 receptor (18 644), triglycerides (425 mg/dL) and splenomegaly supported haemophagocytic lymphohistiocytosis (HLH). Despite plasmapheresis, corticosteroids, etoposide, eculizumab and continuous renal replacement therapy, she died 7 weeks after SARS-CoV-2 infection. Autopsy confirmed aHUS with extensive thrombotic microangiopathy and HLH with bone marrow haemophagocytosis. This case underscores the importance of recognising concurrent aHUS and HLH after COVID-19, as complement-mediated injury and hyperinflammation may produce catastrophic outcomes.

PMID:
42843919
Bibliographic data and abstract were imported from PubMed on 08 Oct 2026.

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