Many young children have unsupervised access to the internet and are using the internet to socialize with others. This has can lead a number of dangerous situations which can be threatening for children. Which problems do children face when going online without parents supervision? How can these problems be solved?

Abstract: Haemophagocytic lymphohistiocytosis (

HLH

) is a rare aggressive condition

due to

abnormal immune activation and hyperinflammatory response. It can be fatal if not treated promptly. Haemophagocytic lymphohistiocytosis frequently affects infants < 3 months of age, but it

also

occurs in children & adults. It can be classified as primary or secondary. Primary

HLH

is caused by genetic mutation and mainly occurs in the paediatric population. Secondary

HLH

is triggered by infections

such

as Dengue, Hepatitis B & C, EBV, CMV, HIV & Covid 19, and rheumatological conditions like SLE and malignancy.

HLH

frequently presents as pyrexia of unknown origin with

pancytopenia

and high transaminases. The diagnosis is mainly based on

HLH

-2004 criteria. Early diagnosis and early initiation of

HLH

-specific therapy may influence the prognosis of the disease. Definite treatment of

HLH

is based on

HLH

- 2004 protocol which includes early use of cyclosporin with corticosteroids and chemotherapy with Etoposide. Here we report a 26-year-old female has presented with prolonged fever with hepatosplenomegaly and

pancytopenia

. She was diagnosed to have

HLH

and treated

according to

HLH

-2004 protocol with cyclosporine, dexamethasone and etoposide. Keywords Haemophagocytic lymphohistiocytosis (

HLH

), abnormal immune activation, Etoposide Case presentation A 26-year-old female presented to the primary care unit with on-and-off fever, lethargy and tiredness for 20 days duration. She had

cough

Correct article usage

a cough

show examples

with sputum for 3 days. She

also

had

loss

Add an article

a loss

show examples

of appetite and loss of weight. She did not have

sore

Add an article

a sore

show examples

throat, night sweats, haemoptysis or contact

history

of Tuberculosis There was no

history

of chest pain, shortness of breath, headache or dizziness. She did not have any features of meningeal irritation. She denied nausea, vomiting, abdominal pain or altered bowel habit. She did not have dysuria, haematuria or increased frequency. Urine output was good. There was no

history

of joint pain, swelling, oral ulcers, excessive hair loss or rashes. She denied any bleeding manifestations s. She denies a

history

of recent travel or contact with animals. There were long terms for long-term drug use. She denied high-risk sexual activity, blood transfusion or drug abuse in the past. There was no significant past medical or family

history

. But she had 3 hospital admissions within the

last

2 months. The first admission was managed as Dengue haemorrhagic fever with Dengue viral hepatitis. Second and third admissions were treated as sepsis with post-viral hepatitis. She had persistent

pancytopenia

with high transaminase levels in all three previous admissions. Menstrual

history

and obstetrics

history

were unremarkable. She is a mother of

the

Correct article usage

a

show examples

ten-month-old child. On examination, she was drowsy, ill-looking pale. She was mildly dyspneic and tachycardic with stable blood pressure. Her oxygen saturation at room air was 90%. There was no neck stiffness or lymphadenopathy. There were no stigmata of Infective endocarditis or features of autoimmune diseases. There were no

tatoo

Correct your spelling

tattoo

or IV injection sites. She had bilateral crepitation in the lung bases and hepatosplenomegaly. The rest of the examinations were normal. Full blood counts showed

pancytopenia

( WBC - 3.11x109/

uL

, Neutrophils – 1.8x109/

uL

, Lymphocytes – 1.05 x109/

uL

, Eosinophils- 0.01x109 /

uL

, Haemoglobin- 5.5 /dl, Platelets- 119x109/

uL

), increased transaminase levels ( AST - 767 U/l, ALT -518 U/l) with hyperferritinemia (-84000 ng/ml) and hypertriglyceridemia (486 mg/dl). Plasma fibrinogen level was normal (240 mg/dl) but the ROTEM study showed mild fibrinogen deficiency.