Absolutely.. HLH is a possibility and marrow haemophagocytosis is not always seen.. but at times these things evolve and we may only have 3-4 of the 8 criteria.. here we would evaluate for both primary causes like perforin assay etc and also look at secondary causes..
Most likely HLH,5 out of 8 should be met,Hemopagocytosis is not necessary to be demonstrated in the bone marrow,can be genetic HLH as all infectious markers are negative,Perforin gene,sytaxin gene mutation