Case Reports and Reviews: Open Access

Atypical Case of Cold Agglutinins Disease (CAD), Hemophagocytic Lymphohistiocytosis (HLH), Narcolepsy, and Polymyalgia Rheumatica (PMR): Case Report & Management Discussion

Raul H. Morales-Borges, Arturo Ortiz-Padua, Carlos E. Jiménez-Marchan, Dana Delgado-Colon, José M. Rodríguez-Medina

Abstract

Cold agglutinins disease (CAD) is a rare type of autoimmune hemolytic anemia. Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease eventually caused or reactivated by a viral infection which can lead to the production of cold agglutinins. Narcolepsy is a sleep disorder caused by a lack of a brain chemical called hypocretin (orexin) secondary to immune attack related to Human Leukocyte Antigen DQB1 (HLA-DQB1). Polymyalgia rheumatica (PMR) is an inflammatory disorder that can be hard to diagnose and usually occurs with another serious condition called giant cell arteritis. We report a case of a 78-years-old male patient with an atypical presentation of possible associated to past Epstein Bar Virus (EBV) or Cytomegalovirus (CMV) and/or HLA. The purpose of this case is defining the first association within all four conditions as well as its biological and clinical manifestations plus the management with glutathione (GSH) as part of integrative therapeutically approach.

Keywords: Cold agglutinins disease; Hemophagocytic lymphohistiocytosis; Narcolepsy; Polymyalgia rheumatica; Atypical case