Successful treatment of acute hepatitis A-associated hemophagocytic syndrome by intravenous immunoglobulin.

Virus-associated hemophagocytic syndrome (VAHS) is a rare complication in acute hepatitis A virus (HAV) infection. There is no standard therapy for VAHS and the clinical course is variable. Data on the use of intravenous immunoglobulin (IVIG) in the treatment of HAV-associated VAHS is limited. We report a previously healthy, 32-year-old man who presented with general malaise, fever, chills and splenomegaly. Laboratory examination showed marked elevation of aminotransferase, leukopenia and thrombocytopenia. Acute hepatitis A was documented by the presence of immunoglobulin M anti-HAV and compatible liver biopsy findings. Bone marrow examination revealed extensive hemophagocytosis. IVIG was administered after the diagnosis of HAV-associated VAHS. His symptoms and laboratory abnormalities improved, and following a smooth recovery he was discharged 1 month after admission.