Unusual Presentation of Hemophagocytic Lymphohistiocytosis in a Kidney Transplant Patient

Table 1

Summary of hospitalizations.

Admission	Clinical features	Discharge Diagnosis
1st (Day 1-5)	Fever and hypotension, which required norepinephrine for few hours, and responded to stress dose hydrocortisone. She became afebrile and hemodynamically stable within 24 hours.	CMV infection (CMV viral load 3.6 IU/ml), Epstein-Barr Virus (EBV) detectable at 282 copies/ml. She was discharged on valganciclovir, and azathioprine was discontinued.
2nd (Day 17-20)	Fever and mild hypotension, which resolved with IV fluid.	CMV infection with improving CMV viremia. Valganciclovir was continued.
3rd (Day 40-42)	Hyperglycemia.	New onset diabetes mellitus. The patient was started on insulin.; CMV viral load became undetectable, but valganciclovir was continued.
4th (Day 44-49)	High grade fever and hypotension, which required norepinephrine for few hours, and responded to stress dose hydrocortisone. The patient became afebrile and hemodynamically stable within 24 hours.	Adrenal insufficiency.; CMV viral load was undetectable, valganciclovir was continued.