TNF and hemophagocytic syndrome: The exact pathogenesis of EBV-HLH remains incompletely understood, but it is currently believed to be linked to aberrant T-cell and NK-cell functions following EBV infection.[19] These cells fail to efficiently clear the virus, resulting in excessive production of cytokines like IFN-γ, TNF-α, and IL-6, which trigger systemic inflammation and a cytokine storm.