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Abstract

Measles-associated hemophagocytic lymphohistiocytosis is a rare and life-threatening condition, particularly in immunocompromised individuals. This case report discusses the management and successful treatment of a 21-month-old unvaccinated male with Down syndrome who developed secondary Hemophagocytic lymphohistiocytosis during follow-up for pneumonia and respiratory failure. The patient presented with rashes, fever, and cough. Despite initial treatment for pneumonia, he developed respiratory failure, requiring transfer to the pediatric intensive care unit. Physical examination revealed a toxic appearance, bilateral coarse crackles, hepatosplenomegaly, and several mobile cervical lymphadenopathies. Laboratory findings included pancytopenia, hypofibrinogenemia, elevated liver enzymes, and high C-reactive protein. Due to suspicion of myocarditis, intravenous immunoglobulin was administered. Bone marrow aspiration confirmed Hemophagocytic lymphohistiocytosis, leading to the initiation of pulse methylprednisolone and interleukin-1 receptor antagonist (anakinra). Polymerase chain reaction testing confirmed the presence of measles virus.The patient received multiple blood component transfusions and was discharged after two weeks. This case demonstrates the critical role of a multidisciplinary approach to manage such complex cases effectively, emphasizing the need for high suspicion, early diagnosis, and appropriate treatment to achieve positive outcomes.

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