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Cytology of secondary hemophagocytic lymphohistiocytosis masquerading as lymphoma in a nonimmunocompromised adult

Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal immune disorder which is uncommon in a nonimmunocompromised adult. A 27-year-old female who presented with fever, hematuria, generalized lymphadenopathy was clinically suspected to have lymphoma was subjected to fine needle aspiration of cervical lymph nodes. Cytology of lymph node had numerous histiocytes with phagocytosed lymphocytes, red blood cells and nuclear debris. A diagnosis of secondary HLH was made based on cytological findings, clinical manifestations, and laboratory results. She was treated with steroids and recovered completely. A high degree of clinical suspicion coupled with comprehensive cytology with fine needle aspiration cytology is fruitful in the diagnosis of HLH, a potentially fatal disease and help in the delineation of therapeutic regimen.