TNF and Hemophagocytosis: The underlying pathogenesis involves abnormal activation of the monocyte-macrophage system, leading to excessive production of pro- inflammatory cytokines (such as tumor necrosis factor-α), suppression of bone marrow hematopoiesis, and hemophagocytosis [16, 17].This dysregulated immune response is closely linked to oxidative stress mechanisms associated with BH4 imbalance, which further anplifies disease severity.