Lactic acidosis in hemophagocytic syndrome: diagnostic and therapeutic challenges in the intensive care unit—a case series
Bibliographic record
Abstract
BACKGROUND: Hemophagocytic lymphohistiocytosis is a life-threatening hyperinflammatory syndrome resulting from uncontrolled activation of T cells and macrophages, frequently leading to multiorgan failure. Severe lactic acidosis (lactate ≥ 10 mmol/L), a rare yet critical manifestation, poses unique diagnostic and therapeutic challenges in the intensive care unit. Here, we report two cases of Chinese men with hemophagocytic lymphohistiocytosis presenting with extreme lactic acidosis, highlighting the necessity of early hemophagocytic lymphohistiocytosis screening in intensive care unit patients with unexplained hyperlactatemia. CASE PRESENTATION: Case 1: A 43-year-old Chinese male with diffuse large B cell lymphoma developed hemophagocytic lymphohistiocytosis, presenting with lactate 14.2 mmol/L, cytopenia, and hyperferritinemia. Etoposide therapy rapidly normalized lactate levels (within 24 hours) and led to complete recovery after autologous stem cell transplantation. Case 2: A 60-year-old Chinese male with chronic gout and soft tissue infection developed septic shock and reactive hemophagocytic lymphohistiocytosis (lactate 14.3 mmol/L). Despite initial response to etoposide, he succumbed to invasive aspergillosis due to treatment-related immunosuppression. CONCLUSION: Extreme lactic acidosis in intensive care unit patients should prompt urgent hemophagocytic lymphohistiocytosis evaluation, particularly in Chinese populations. Etoposide is effective for malignancy-associated hemophagocytic lymphohistiocytosis, while reactive hemophagocytic lymphohistiocytosis may require tailored immunosuppression with strict infection prophylaxis. Routine reporting of patient ethnicity aids epidemiological understanding of rare diseases such as hemophagocytic lymphohistiocytosis.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".