Reactive hemophagocytosis in a patient with systemic lupus erythematosus and disseminated histoplasmosis

We report a 16 year-old girl with systemic lupus erythematosus, treated with prednisone and mycophenolate, who developed fever of unknown origin. Her laboratory evaluation demonstrated reactive hemophagocytosis, the cause of which was ultimately determined to be disseminated infection with Histoplasma capsulatum. Treatment of the fungal infection led to rapid resolution of her hemophagocytic syndrome. This is the first reported case of histoplasmosis- induced hemophagocytic syndrome reported in an adolescent patient.