Hemophagocytic syndrome (HS) is a severe hyper inflammatory condition whose 
cardinal symptoms are prolonged fever, cytopenia, hepatosplenomegaly, and 
hemophagocytosis by activated, morphologically benign macrophages. The clinical 
course resembles sepsis, sharing similar physiopathological features. We report 
four patients with the syndrome. A 61-year-old female presenting with fever and 
pleuritic pain. During the course of the disease, a pancytopenia was detected 
and a bone marrow aspiration was suggestive of HS. The patient was treated with 
cyclosporine and steroids with a good response. A 61-year-old male with fever 
and pancytopenia and a bone marrow aspirate suggestive of HS. The patient did 
not respond to treatment and died. A 23-year-old male with fever, pancytopenia 
and positive Hanta virus antibodies. A bone marrow aspirate was suggestive of 
HS. The patient recovered without any treatment. A 72-year-old male admitted 
with the diagnosis of pneumonia, that developed a progressive pancytopenia and 
bone marrow aspirate was suggestive of HS. A bronchoalveolar lavage showed the 
presence of Acinetobacter baumanii. Despite treatment with methylprednisolone 
and gammaglobulin, the patient died. Awareness of the clinical symptoms and of 
the diagnostic criteria of HS is important to start life-saving therapy in time.