Secondary Hemophagocytic Lymphohistocytosis in COVID-19

Authors

  • Stephanie Lilia Pushpam Jetty Department of Pathology Father Muller Medical College Kankanady, Mangalore, Karnataka, India, 575002
  • Dotton Denis Noronha Department of Critical care & Internal medicine A.J. Hospital & Research Centre Kuntikana, Mangalore, Karnataka, India, 575004
  • Akshatha Nayak Department of Hematology A.J. Hospital & Research Centre Kuntikana, Mangalore, Karnataka, India, 575004
  • Altin Dsouza Department of Respiratory Therapy A.J. Hospital & Research Centre Kuntikana, Mangalore, Karnataka, India, 575004

DOI:

https://doi.org/10.21276/apalm.3030

Keywords:

Hemophagocytic lymphohistiocytosis, COVID-19, Severe Acute Respiratory Infection

Abstract

 We present case of a 53-year-old lady who is a known case of rheumatoid arthritis and hypertension in Karnataka, South India, who presented with Severe Acute Respiratory Infection (SARI) like symptoms  (fever, cough and breathlessness) due to COVID-19. During the course of treatment further investigations revealed evidence of Hemophagocytic Lymphohistocytosis (HLH). This case emphasizes the need for a thorough workup to identify the etiology of HLH as it may unmask a treatable entity in a COVID-19 patient.

References

Atteritano, M., David, A., Bagnato, G., Beninati, C., Frisina, A., Iaria, C. & Cascio, A. (2012) Haemophagocytic syndrome in rheumatic patients. A systematic review. European Review for Medical and Pharmacological Sciences, 16, 1414– 24.

Janka, G.E. & Lehmberg, K. (2014) Hemophagocytic syndromes †An update. Blood Reviews, 28, 135– 142.

Ramosâ€Casals, M., Britoâ€Zerón, P., Lópezâ€Guillermo, A., Khamashta, M.A. & Bosch, X. (2014) Adult haemophagocytic syndrome. Lancet, 383, 1503– 16.

Kasahara, Y., Yachie, A., Takei, K., Kanegane, C., Okada, K., Ohta, K., Seki, H., Igarashi, N., Maruhashi, K., Katayama, K., Katoh, E., Terao, G., Sakiyama, Y. & Koizumi, S. (2001) Differential cellular targets of Epsteinâ€Barr virus (EBV) infection between acute EBVâ€associated hemophagocytic lymphohistiocytosis and chronic active EBV infection. Blood, 98, 1882– 1888.

Rouphael, N.G., Talati, N.J., Vaughan, C., Cunningham, K., Moreira, R. & Gould, C. (2007) Infections associated with haemophagocytic syndrome. The Lancet. Infectious diseases, 7, 814– 822.

George, M.R. (2014) Hemophagocytic lymphohistiocytosis: review of etiologies and management. Journal of Blood Medicine, 5, 69– 86.

Atteritano, M., David, A., Bagnato, G., Beninati, C., Frisina, A., Iaria, C. & Cascio, A. (2012) Haemophagocytic syndrome in rheumatic patients. A systematic review. European Review for Medical and Pharmacological Sciences, 16, 1414– 24.

Zhang, M., Behrens, E.M., Atkinson, T.P., Shakoory, B., Grom, A.A. & Cron, R.Q. (2014b) Genetic defects in cytolysis in macrophage activation syndrome. Current Rheumatology Reports, 16, 439– 446.

Grom, A., Villanueva, J., Lee, S., Goldmuntz, E., Passo, M. & Filipovich, A.H. (2003) Natural killer cell dysfunction in patients with systemicâ€onset rheumatoid arthritis and macrophage activation syndrome. Journal of Pediatrics, 29, 2– 296.

Ramanan, A.V. & Schneider, R. (2003) Macrophage activation syndrome–what's in a name!. The Journal of Rheumatology, 30, 2513– 6.

Grom, A.A. (2004) Natural killer cell dysfunction: a common pathway in systemicâ€onset juvenile rheumatoid arthritis, macrophage activation syndrome, and hemophagocytic lymphohistiocytosis? Arthritis and Rheumatism, 50, 689– 98.

Bryceson, Y.T., Pende, D., Maulâ€Pavicic, A., Gilmour, K.C., Ufheil, H., Vraetz, T., Chiang, S.C., Marcenaro, S., Meazza, R., Bondzio, I., Walshe, D., Janka, G., Lehmberg, K., Beutel, K., zur Stadt, U., Binder, N., Arico, M., Moretta, L., Henter, J.I. & Ehl, S. (2012) A prospective evaluation of degranulation assays in the rapid diagnosis of familial hemophagocytic syndromes. Blood, 119, 2754– 2763.

Avau, A., Put, K., Wouters, C.H. & Matthys, P. (2015) Cytokine balance and cytokineâ€driven natural killer cell dysfunction in systemic juvenile idiopathic arthritis. Cytokine & Growth Factor Reviews, 26, 35– 45.

Canna, S.W. & Goldbachâ€Mansky, R. (2015) New monogenetic autoinflammatory diseases—a clinical overview. Seminars in Immunopathology, 37, 387– 394.

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Published

28-02-2021

How to Cite

1.
Jetty SLP, Noronha DD, Nayak A, Dsouza A. Secondary Hemophagocytic Lymphohistocytosis in COVID-19. Ann of Pathol and Lab Med [Internet]. 2021 Feb. 28 [cited 2024 Nov. 19];8(2):C25-29. Available from: https://pacificejournals.com/journal/index.php/apalm/article/view/3030

Issue

Vol. 8 No. 2 (2021)

Section

Case Report

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Copyright (c) 2021 Stephanie Lilia Pushpam Jetty, Dotton Denis Noronha, Akshatha Nayak, Altin Dsouza

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