An enigmatic tale of macrophages in bone marrow causing inflammation of the brain: A case report on CNS HLH
Bibliographic record
Abstract
BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening immune disorder characterized by excessive inflammation and multiorgan involvement. Rarely, HLH can manifest with signs and symptoms isolated to the central nervous system (CNS). This case report highlights the unique clinical course of CNS-isolated HLH in a 19-year-old female who, despite a nine-year delay in diagnosis, achieved disease remission following a hematopoietic stem cell transplant (HSCT). CASE: The patient initially presented at 9 years old with seizures, ataxia, and progressive cognitive decline. Over the next nine years, extensive diagnostic evaluations were performed, including neuroimaging, cerebrospinal fluid analysis, and genetic testing. Genetic testing identified a compound heterozygous mutation in the PRF1 gene, confirming a diagnosis of familial HLH (FHL). The patient underwent hematopoietic stem cell transplant (HSCT) from an HLA-matched unrelated donor. Despite significant complications, including multiple infections and renal failure, she achieved remission. Six years post-transplant, the patient exhibited stabilization of neurological function, cessation of seizures, and absence of active HLH. CONCLUSION: This case underscores the importance of considering genetic testing in patients with unexplained CNS symptoms and atypical radiological findings. Timely HSCT, even in cases with delayed diagnosis, can lead to remission and improved quality of life.
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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 | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 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 | 0.000 |
| 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".