From EBV-Induced Hemophagocytic Lymphohistiocytosis to COVID-19 triggered Sweet Syndrome: A Polyphasic Clinical Journey

Hemophagocytic Lymphohistiocytosis (HLH) and Sweet Syndrome are two hyperinflammatory conditions, which can be genetic or precipitated by infections, primary immunodeficiencies, autoimmune conditions, or certain therapies and transplants. HLH results because of a exaggerated response by the dysregulated CD+ T cells, leading to widespread activation of macrophages, resulting in hemophagocytosis and excessive, organ-damaging inflammation. Sweet syndrome is another uncommon condition, presenting as sudden onset of painful, edematous, and erythematous papules, plaques, or nodules on the skin, precipitated by the same. It is unusual for them to present sequentially, so herein we present a case of two distinct hyperinflammatory syndromes, Epstein Bar Virus-triggered HLH followed by COVID-19 triggered necrotizing Sweet Syndrome, both occurring in a 53-year-old patient with history of remote history of juvenile idiopathic arthritis within a short time span.