{"id":232229,"date":"2026-02-27T13:17:31","date_gmt":"2026-02-27T19:17:31","guid":{"rendered":"https:\/\/lifeboat.com\/blog\/2026\/02\/steroid-refractory-pembrolizumab-induced-haemophagocytic-lymphohistiocytosis-hlh-successfully-treated-with-anakinra-a-case-report"},"modified":"2026-02-27T13:17:31","modified_gmt":"2026-02-27T19:17:31","slug":"steroid-refractory-pembrolizumab-induced-haemophagocytic-lymphohistiocytosis-hlh-successfully-treated-with-anakinra-a-case-report","status":"publish","type":"post","link":"https:\/\/lifeboat.com\/blog\/2026\/02\/steroid-refractory-pembrolizumab-induced-haemophagocytic-lymphohistiocytosis-hlh-successfully-treated-with-anakinra-a-case-report","title":{"rendered":"Steroid-Refractory Pembrolizumab-Induced Haemophagocytic Lymphohistiocytosis (HLH) Successfully Treated With Anakinra: A Case Report"},"content":{"rendered":"<p><a class=\"aligncenter blog-photo\" href=\"https:\/\/lifeboat.com\/blog.images\/steroid-refractory-pembrolizumab-induced-haemophagocytic-lymphohistiocytosis-hlh-successfully-treated-with-anakinra-a-case-report.jpg\"><\/a><\/p>\n<p>This stage IV lung cancer patient developed: persistent fever thrombocytopenia multiorgan dysfunction steroid-refractory course.<\/p>\n<p>A high H-score led to the diagnosis: ICI-associated HLH. She improved rapidly with anakinra after failing steroids.<\/p>\n<p>Takeaway: In immunotherapy patients, extreme hyperferritinaemia should trigger HLH evaluation early.<\/p>\n<p>Would you have escalated to anakinra\u2026or tried second-line steroids first?<\/p>\n<p>Read more here.<\/p>\n<hr>\n<p>Immune checkpoint inhibitors (ICIs) are increasingly used in advanced malignancies but can cause rare, severe immune-related adverse events (irAEs). Haemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome infrequently reported with ICIs and often challenging to diagnose. We report a case of a woman in her 60s with stage IV lung adenocarcinoma treated with pembrolizumab-based chemoimmunotherapy who developed recurrent, steroid-refractory immune-related hepatitis and pneumonitis. Twenty-four weeks after starting pembrolizumab, she presented with persistent fever, thrombocytopenia, extreme hyperferritinaemia (ferritin &gt;33,500 \u00b5g\/L), and progressive multiorgan dysfunction. Despite overlap with other irAEs and infection, a high H-score prompted evaluation for HLH, confirmed on bone marrow biopsy with haemophagocytosis.<\/p>\n<div class=\"more-link-wrapper\"> <a class=\"more-link\" href=\"https:\/\/lifeboat.com\/blog\/2026\/02\/steroid-refractory-pembrolizumab-induced-haemophagocytic-lymphohistiocytosis-hlh-successfully-treated-with-anakinra-a-case-report\">Continue reading \u201cSteroid-Refractory Pembrolizumab-Induced Haemophagocytic Lymphohistiocytosis (HLH) Successfully Treated With Anakinra: A Case Report\u201d | &gt;<\/a><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This stage IV lung cancer patient developed: persistent fever thrombocytopenia multiorgan dysfunction steroid-refractory course. A high H-score led to the diagnosis: ICI-associated HLH. She improved rapidly with anakinra after failing steroids. Takeaway: In immunotherapy patients, extreme hyperferritinaemia should trigger HLH evaluation early. Would you have escalated to anakinra\u2026or tried second-line steroids first? Read more here. [\u2026]<\/p>\n","protected":false},"author":662,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-232229","post","type-post","status-publish","format-standard","hentry","category-biotech-medical"],"_links":{"self":[{"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/posts\/232229","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/users\/662"}],"replies":[{"embeddable":true,"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/comments?post=232229"}],"version-history":[{"count":0,"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/posts\/232229\/revisions"}],"wp:attachment":[{"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/media?parent=232229"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/categories?post=232229"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/tags?post=232229"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}