New england journal of medicine case report

The New England Journal of Medicine (NEJM) is a prestigious medical journal that publishes original research, reviews, and case reports in various fields of medicine. Here's a sample case report that might be published in the NEJM:

Title: A Rare Case of Autoimmune Hemolytic Anemia Complicated by Hemophagocytic Lymphohistiocytosis

Abstract:

We report a rare case of autoimmune hemolytic anemia (AIHA) complicated by hemophagocytic lymphohistiocytosis (HLH) in a 35-year-old woman. The patient presented with symptoms of fatigue, pallor, and jaundice, and was found to have a hemoglobin level of 6.5 g/dL. Laboratory tests revealed a positive direct antiglobulin test and a high reticulocyte count. Despite treatment with corticosteroids and immunoglobulin, the patient's anemia worsened, and she developed fever, rash, and lymphadenopathy. A bone marrow biopsy revealed hemophagocytosis, and a diagnosis of HLH was made. The patient was treated with etoposide, corticosteroids, and immunoglobulin, and her symptoms improved. This case highlights the importance of considering HLH in patients with AIHA who do not respond to standard treatment.

Case Report:

A 35-year-old woman presented to our hospital with a 2-month history of fatigue, pallor, and jaundice. She had no significant medical history and was not taking any medications. Physical examination revealed a pale complexion, a palpable spleen, and mild jaundice. Laboratory tests showed a hemoglobin level of 6.5 g/dL, a mean corpuscular volume of 90 fL, and a reticulocyte count of 15%. The direct antiglobulin test was positive, and the indirect antiglobulin test was negative. A peripheral blood smear showed fragmented red blood cells and spherocytes.

The patient was treated with corticosteroids and immunoglobulin, but her anemia worsened over the next 2 weeks. She developed fever, rash, and lymphadenopathy, and her liver function tests became abnormal. A bone marrow biopsy was performed, which revealed hemophagocytosis, characterized by the presence of activated macrophages and lymphocytes that were engulfing red blood cells, white blood cells, and platelets.

A diagnosis of hemophagocytic lymphohistiocytosis (HLH) was made, and the patient was treated with etoposide, corticosteroids, and immunoglobulin. Her symptoms improved over the next 4 weeks, and her liver function tests returned to normal. The patient was discharged from the hospital and continued to receive treatment with corticosteroids and immunoglobulin.

Discussion:

Autoimmune hemolytic anemia (AIHA) is a rare condition characterized by the destruction of red blood cells by antibodies. Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening condition characterized by the uncontrolled activation of macrophages and lymphocytes, leading to the destruction of red blood cells, white blood cells, and platelets.

The diagnosis of HLH is often challenging, and it requires a high index of suspicion. The presence of hemophagocytosis in the bone marrow biopsy is a key diagnostic feature. Treatment of HLH typically involves a combination of corticosteroids, immunoglobulin, and chemotherapy.

In this case, the patient's AIHA was complicated by HLH, which was diagnosed based on the presence of hemophagocytosis in the bone marrow biopsy. The patient was treated with etoposide, corticosteroids, and immunoglobulin, and her symptoms improved. This case highlights the importance of considering HLH in patients with AIHA who do not respond to standard treatment.

Conclusion:

This case report highlights the importance of considering hemophagocytic lymphohistiocytosis (HLH) in patients with autoimmune hemolytic anemia (AIHA) who do not respond to standard treatment. HLH is a rare and life-threatening condition that requires a high index of suspicion and prompt treatment. A bone marrow biopsy is a key diagnostic tool in the diagnosis of HLH, and treatment typically involves a combination of corticosteroids, immunoglobulin, and chemotherapy.