Ruxolitinib combined with azithromycin for scrub typhus-associated hemophagocytic lymphohistiocytosis in a child: a case report and narrative literature review

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Scrub typhus-associated hemophagocytic lymphohistiocytosis (HLH) in children has a mortality rate of 11.9%–30% and often requires effective anti-rickettsial therapy.
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A 5-year-11-month-old girl with scrub typhus-associated HLH was treated with ruxolitinib and azithromycin, resulting in rapid clinical improvement.
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The patient met six of eight HLH-2004 diagnostic criteria and showed normalization of laboratory parameters by day 8 of treatment.
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This case is the first report of successful JAK1/2 inhibitor therapy in scrub typhus-associated HLH, suggesting a potential new treatment avenue.
5

A literature review of 66 pediatric cases indicated that corticosteroids and intravenous immunoglobulin were commonly used, but outcomes varied.

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