An Adult Case of Virus Associated Hemophagocytic Syndrome Which Developed from Infectious Mononucleosis.

An adult case of virus associated hemophagocytic syndrome (VAHS) which developed from infectious mononucleosis (IM) is reported. A 21-year-old-man visited our clinic with complaints of high fever, sore throat, and cervical lymphadenopathy. The palatine tonsils appeared to be swollen with white plugs on the surface. Hematological examination revealed mononucleosis with atypical lymphocytes in the peripheral blood. The serum LDH level was elevated. Serum antibodies to Epstein-Barr virus (EBV) showed a primary infection pattern. The patient, on the basis of these findings, was initially diagnosed with IM. The symptoms and laboratory data subsequently showed transient improvement; however, liver dysfunction, pancytopenia, and interstitial pneumonia ultimately developed. Bone marrow puncture was performed 29 days after admission and revealed inflitration of a number of mature histiocytes with erythrophagia, suggesting that VAHS had developed from IM. Combined chemotherapy with prednisolone, interferon, acyclovir, and VP-16, was not effective, and progressive liver dysfunction and pancytopenia advanced. He died 47 days later of disseminated intravascular coagulopathy.