Table 3. Cases of HLH secondary to Aspergillus infection.

BAL: brohchoalveolar lavage, BM: bone marrow, HLH: hemophagocytic lymphohistiocytosis, NK: natural killer cells, ANA: antinuclear antibodies, 

Case	Age In years	Presentation	ferritin	BM biopsy	BAL	Other significant laboratory tests	Diagnosis	Treatment	Outcome
Karakosta et al., 2021 [8]	68	Fever and respirator distress	4062 ng/ml then increased to 23,863 ng/ml	histiocytosis	Revealed Aspergillus flavus	Elevated Triglycerides and pancytopenia	Acquired Hemophagocytic lymphohistiocytosis secondary to invasive pulmonary aspergillosis and Turicella Otitidis bacteremia	Broad spectrum antibiotics, Itraconazole and IV Hydrocortisone	death
Schouten MJG et al., 2017 [9]	38	Respiratory failure and fever	2961 ng/ml	Not done	positive for influenza-A and aspergillus fumigatus	Low NK activity	HLH secondary to influenza and invasive pulmonary aspergillosis	-Anakinra (interleukin-1 receptor antagonist), Antiviral (oseltamivir), Antifungal (amphotericin-B and voriconazole) and Interferon-gamma	death
Umekawa et al., 2020 [10]	54	Fever, dyspnea and skin rash	14.790 ng/ml	not done	Revealed Aspergillus fumigatus	ANA 1:80, elevated CD25 3,970 pg/ml and Decreased NK cell activity	Secondary Hemophagocytic Lymphohistiocytosis Associated with Invasive pulmonary Aspergillosis and the patient was eventually diagnosed with dermatomyositis	IVIG and antifungal therapy	Improved then the patient developed recurrence of secondary HLH associated with disseminated tuberculosis
Paul M, et al., 2022 [11]	68	Fever, Acute respiratory distress and Impaired consciousness	141,918 ng/ml	hemophagocytosis	BAL was not done, the patient had positive serum galactomannan	Elevated triglycerides	HLH secondary to mucormycosis and aspergillosis coinfection	Etoposide, steroid therapy, Tocilizumab and Antifungal therapy	death
Gandotra A, et al., 2022 [12]	47	Fever and respiratory distress in a liver transplant recipient who was recovering from severe COVID-19 infection	27,717 ng/ml	hemophagocytosis	Not done	Sputum culture was positive for acid fast bacilli and sputum fungal culture was positive for Aspergillus Flavus	Invasive pulmonary Aspergillosis and Tuberculosis complicated by HLH in sequelae of COVID-19 in a liver transplant recipient	IVIG, Antitubercular therapy and Antifungal therapy	recovered
Bello, A et al., 2018 [13]	9	Fever with respiratory distress	14,000 ng/ml	Not done	Not done	Elevated triglycerides	Aspergillus induced HLH in child with acute lymphoblastic leukemia	Antifungal therapy	recovered