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Discussion: There have been five clusters of donor-derived LCMV transmissions reported with clinical features of sepsis, AMS, and progression to MOF. Our patient’s HLH was likely triggered by LCMV viremia, and complicated with EBV/CMV reactivation. Viral mediated complement activation resulted in additional possible cmTMA. Although the patient’s clinical markers started to show some improvement with treatment, the patient had profound MOF by then. As we continue to increase organ transplantation, it is important to keep LCMV infection and the MOF clinical syndromes (HLH and cmTMA) that result in intensive care treatment.