BIRMINGHAM — Edwin Villarreal, an Alabama hospitalist, has made a full recovery one year after undergoing a high-risk splenectomy to treat a life-threatening immune disorder. His case at the University of Alabama at Birmingham (UAB) illustrates how aggressive intervention can alter the trajectory of a condition that otherwise carried a 100% mortality rate.

Villarreal first noticed recurring fevers, weight loss, and chills after exercising in January 2024. A subsequent CT scan in an emergency room revealed an enlarged spleen, but his blood count was too low to safely perform a spleen biopsy. Physicians could not begin chemotherapy without identifying the underlying cause of his symptoms.

By August 2024, Villarreal was hospitalized at UAB, where he was diagnosed with hemophagocytic lymphohistiocytosis (HLH), an aggressive condition in which the immune system becomes dangerously overactive. Doctors determined his HLH was caused by an underlying lymphoma, later identified as diffuse large B-cell lymphoma—an aggressive form believed to have triggered the immune disorder. Without intervention, Villarreal’s condition carried a 100% mortality rate.

A multidisciplinary UAB team met to weigh the risks of removing Villarreal’s spleen. Dr. Sushanth Reddy, a UAB surgical oncologist, told Villarreal he might have only a week or two to live without the operation and warned that he might not survive the procedure due to the risk of bleeding. “Dr. Reddy told me that, if we don’t do this, you probably have a week or two weeks left, if anything,” Villarreal recalled. “The problem is, if I take you to the operating table, you may not survive either because you may bleed out.” Villarreal chose to proceed with the splenectomy surgery the morning after the consultation.

Villarreal’s medical metrics began improving almost immediately after his spleen was removed. The surgery allowed doctors to finally diagnose diffuse large B-cell lymphoma, enabling physicians to begin chemotherapy after monitoring his surgical recovery. Villarreal completed chemotherapy with virtually no side effects and has now been cancer-free for one year.

Villarreal’s case has broader implications for treating rare disorders in Alabama. UAB, home to the O’Neal Comprehensive Cancer Center—the state’s only National Cancer Institute-designated cancer center—uses his case to train residents. The institution has also launched a clinical trial focused on HLH, a condition more commonly seen in children than adults.

“However, when the mortality without doing the procedure is 100 percent, the risk-benefit ratio changes quite a bit,” said Dr. Gaurav Goyal, an associate professor in UAB’s Division of Hematology and Oncology who specializes in rare disorders such as HLH. “Edwin’s case truly shows what’s possible when you have that level of collaboration under one roof,” he added.