PURPOSE: The clinical findings of almost all of the hemophagocytic lymphohistiocytosis (HLH) patients are not significant. Early enforcement of bone marrow study for quicker detection of laboratory abnormalities in routine laboratory test, which is perfomed in febrile patients, is critical for early diagnosis of HLH. In this study, we tried to elucidate more significant laboratory test for the early diagnosis of HLH. METHODS: The study group and control group consisted of 13 HLH patients, and 46 febrile patients with causes like fever of unknown origin, kawasaki disease or acute lymphoblastic leukemia, respectively. Receiver operating characteristic (ROC) curve analysis of various laboratory findings of hyperpyrexic patients on the first day of admission were performed. RESULTS: The total WBC count, platelet count, serum triglyceride, serum transaminase, and serum ferritin revealed statistically significant differences between the study and the control group (P< 0.05). The ROC curve analysis revealed that serum triglyceride was the most efficient test for the differential diagnosis between HLH and febrile patients with other causes. And the serum transaminase, triglyceride and ferritin revealed a statistically significant difference between the study and the leukemia patients group (P< 0.05). The ROC curve analysis revealed that serum transaminase was the most efficient test for differential diagnosis between HLH and acute leukemia. CONCLUSION: In patients with persistent hyperpyrexia, the elevated serum triglyceride level is an important clue for the early diagnosis of HLH. In patient with persistent hyperpyrexia, and abnormal CBC findings, the elevated serum transaminase level is an important clue for the early diagnosis of HLH.
Bone Marrow ; Diagnosis, Differential ; Early Diagnosis ; Ferritins ; Fever of Unknown Origin ; Humans ; Leukemia ; Lymphohistiocytosis, Hemophagocytic* ; Mucocutaneous Lymph Node Syndrome ; Platelet Count ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; ROC Curve* ; Triglycerides

Pulmonary gangrene is a rare complication of severe pulmonary infection in which a pulmonary segment or lobe is sloughed. It is a part of a spectrum of disease in which lung tissue is devitalized(such as necrotizing pneumonia, pulmonary abscess), but apart from them, pulmonary gangrene has mo re extensive area of necrosis and thrombosis of large vessels plays a prominent role in the pathogenesis. We experienced a case of pulmonary gangrene in 71 year old female obstructive pneumonia patient with non-small cell lung carcinoma. She complained high fever, chill and despite treatment with antibiotics, pneumonia progressed to empyema. At that time chest radiograph showed a large cavity including sloughed lung tissue, freely moving to dependent position at both lateral decubitus view. RML and RLL were resected and compression of pulmonary vessels by enlarged lymph nodes was observed. Defervescence was obtained immediate postoperative period and the patient was discharged after infection control with antibiotics, chest tube drainage. The perivascular ly mph nodes dissected during lobectomy were proved to be reactive hyperplasias. We speculated that the carcinoma caused obstructive pneumonia, in turn, resulted in reactive hyperplasia of the draining lymph nodes surrounding the large vessels and finally the lung tissues supplied by them necrotized and sloughed.
Aged ; Anti-Bacterial Agents ; Chest Tubes ; Drainage ; Empyema ; Female ; Fever ; Gangrene* ; Humans ; Hyperplasia ; Infection Control ; Lung* ; Lymph Nodes ; Necrosis ; Pneumonia* ; Postoperative Period ; Radiography, Thoracic ; Thrombosis

Pulmonary gangrene is a rare complication of severe pulmonary infection in which a pulmonary segment or lobe is sloughed. It is a part of a spectrum of disease in which lung tissue is devitalized(such as necrotizing pneumonia, pulmonary abscess), but apart from them, pulmonary gangrene has mo re extensive area of necrosis and thrombosis of large vessels plays a prominent role in the pathogenesis. We experienced a case of pulmonary gangrene in 71 year old female obstructive pneumonia patient with non-small cell lung carcinoma. She complained high fever, chill and despite treatment with antibiotics, pneumonia progressed to empyema. At that time chest radiograph showed a large cavity including sloughed lung tissue, freely moving to dependent position at both lateral decubitus view. RML and RLL were resected and compression of pulmonary vessels by enlarged lymph nodes was observed. Defervescence was obtained immediate postoperative period and the patient was discharged after infection control with antibiotics, chest tube drainage. The perivascular ly mph nodes dissected during lobectomy were proved to be reactive hyperplasias. We speculated that the carcinoma caused obstructive pneumonia, in turn, resulted in reactive hyperplasia of the draining lymph nodes surrounding the large vessels and finally the lung tissues supplied by them necrotized and sloughed.
Aged ; Anti-Bacterial Agents ; Chest Tubes ; Drainage ; Empyema ; Female ; Fever ; Gangrene* ; Humans ; Hyperplasia ; Infection Control ; Lung* ; Lymph Nodes ; Necrosis ; Pneumonia* ; Postoperative Period ; Radiography, Thoracic ; Thrombosis