PMC9731208_01
Clinical course for the patient. (A) Etoposide, dexamethasone, and ruxolitinib were used as bridging therapies. Hydrocortisone was given for maintenance therapy. (B) The clinical course of hepatosplenomegaly. (C) The panel shows the trajectory of chemokine ligand 9 (CXCL9) and interleukin-18 (IL-18). (D). The panel shows the course of interleukin-6 (IL-6) and C-reactive protein (CRP). (E) The panel shows the course of ferritin, soluble interleukin-2 receptor (sIL-2R), and soluble tumor necrosis factor receptor type II (sTNF-RII) (F) The panel shows the timing of red blood cell (RBC) and platelet concentrate (PC) transfusion, and complete blood count tracking.
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U/mL), which suggested HLH ( Figures 1A, B ,  F ), and referred to our hospital. Upon admission, physical examination revealed fever, decreased oxygenation (SpO2 93% on room air), hepatosplenomegaly, and a skin rash ( Figure 1B ). Complete blood count showed pancytopenia, with white blood cells 2,800/microL, neutrophils 840/microL, hemoglobin level 7.4 g/dL, and platelets 2.9 x 104/microL ( Figure 1F ). All serum cytokine levels were elevated with IL-6 6 pg/mL (normal, <3 pg/mL), IL-18 7,300 pg/mL (normal, <500 pg/mL), CXCL9 8,116 pg/mL (normal, 31-83 pg/mL), and sTNF-RII 27,008 pg/mL (normal, 829-2,262 pg/mL) ( Figures 1C-E ). DEX administration was started at a two-thirds dose ( Figure 1A ).