DOI: 10.12890/2025_005887

Febrile rash, shock, and hyperferritinaemia in a young woman: navigating the diagnostic overlap of hemophagocytic lymphohistiocytosis, toxic shock, and viral exanthema

Authors

  • Pavankumar Hulikere Srinivasaiah Emergency Medicine, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; Emergency Medicine, Severn PGME School of Emergency Medicine, Bristol, UK
  • Kasi Vishwanath Surabhi Acute Medicine, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK

hspavan8@gmail.com

Keywords

Hyperferritinaemia, hemophagocytic lymphohistiocytosis, toxic shock syndrome, viral exanthem, febrile rash

Abstract

Background: Fever, rash, and shock in adults pose diagnostic and therapeutic challenges. Markedly elevated ferritin often raises suspicion for hemophagocytic lymphohistiocytosis (HLH), yet hyperferritinaemia is also encountered in sepsis, adult-onset Still’s disease (AOSD), and viral infections.
Case report: We describe the case of a 27-year-old woman who developed a high fever, diffuse erythematous rash, hypotension, and markedly elevated ferritin levels. The initial differential diagnoses included toxic shock syndrome, HLH, AOSD, and viral exanthema. Extensive evaluations for infectious, autoimmune, and malignant diseases were negative. Imaging demonstrated gallstones with gallbladder wall inflammation, which was likely the trigger for the systemic inflammatory response. With supportive care and early multidisciplinary input, the patient made a full recovery without the need for immunosuppressive therapy.
Conclusion: This case highlights the importance of contextualising ferritin elevation and maintaining a broad differential diagnosis. Serial laboratory trends, careful use of HLH scoring systems, and multidisciplinary collaboration prevented premature immunosuppression and ensured a favourable outcome.

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References

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Published

2025-11-04

Issue

Vol. 12 No. 12 (2025)

Categories

How to Cite

1.
Hulikere Srinivasaiah P, Vishwanath Surabhi K. Febrile rash, shock, and hyperferritinaemia in a young woman: navigating the diagnostic overlap of hemophagocytic lymphohistiocytosis, toxic shock, and viral exanthema. EJCRIM [Internet]. 2025 Nov. 4 [cited 2026 Nov. 3];12(12). Available from: https://ejcrim.com/index.php/ejcrim/article/view/5887