Case report: a fatal combination of hemophagocytic lymphohistiocytosis with extensive pulmonary microvascular damage in COVID-19 pneumonia

Thüsen, Jan H. von der; Bommel, Jasper van; Kros, Johan M.; Verdijk, Robert M.; Lopuhaä, Boaz; Lam, King H.; Dik, Willem A.; Miedema, Jelle

doi:10.1007/s12308-020-00423-7

Cited by 8 publications

(5 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Child cases (16 years old and younger), and suspected or unproven HLH cases were not included in the study. We found 21 more adult cases diagnosed with COVID-19-associated HLH in addition to ours [9][10][11][12][13][14][15][16][17][18][19]. Eighteen (86%) of the patients were over the age of 50 (range 17-84), 16 (76%) were male, and most of them had at least one underlying disease.…”

Section: Review Of Other Covid-19 Associated Hlh Casesmentioning

confidence: 52%

A case of Hemophagocytic lymphohistiocytosis induced by COVID-19, and review of all cases reported in the literature

Kayaaslan

Asilturk

Eser

et al. 2021

J Infect Dev Ctries

View full text Add to dashboard Cite

Novel coronavirus infections 2019 (COVID-19) associated hyperinflammatory syndromes are well-defined clinical conditions and have a potential risk for severe infection. Hemophagocytic lymphohistiocytosis (HLH), a rare type of acute progressive hyperinflammatory syndrome, has been reported in a limited number of COVID-19 cases. In this article, we aimed to present a patient with HLH secondary to COVID-19 diagnosed by bone marrow biopsy, and to summarize and review HLH cases associated with COVID-19 in the literature. A 47-year-old male patient presented with complaints of fever, cough, abdominal discomfort, and nausea-vomiting. He had recovered from COVID-19 a month ago and was readmitted to the hospital due to the re-appearance of clinical symptoms after a two-week interval. The patient was diagnosed with HLH secondary to COVID-19 on sixth day of admission and fully recovered with systemic pulse steroid, intravenous immunoglobulin, and plasma exchange therapy. Analysis of literature searches revealed that 22 cases were definitely diagnosed with COVID-19-associated HLH, 16 of them were male. They had been treated with different anti-cytokine drugs, of which nine had died. The increasing number of HLH cases, which have high mortality rates, shows the importance of hyperinflammatory syndromes in COVID-19 patients. Some patients may experience hemophagocytosis in the late period of COVID-19, even while in recovery. Increased awareness and early treatment for HLH triggered by COVID-19 can be a life-saving effort for reducing mortality in severe COVID-19 cases.

show abstract

Section: Review Of Other Covid-19 Associated Hlh Casesmentioning

confidence: 52%

A case of Hemophagocytic lymphohistiocytosis induced by COVID-19, and review of all cases reported in the literature

Kayaaslan

Asilturk

Eser

et al. 2021

J Infect Dev Ctries

View full text Add to dashboard Cite

show abstract

“…There are case reports of SARS-CoV-2-induced sHLH diagnosed antemortem (11)(12)(13)(14)(15) and postmortem (1,(16)(17)(18)(19) while the illness is/was ongoing, as shown in Table 2B. However, the literature is sparse about COVID-19 recovered cases developing sHLH (8)(9)(10), as shown in Table 2B.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Secondary Hemophagocytic Lymphohistiocytosis (sHLH) and Candida auris Fungemia in Post-acute COVID-19 Syndrome: A Clinical Challenge

et al. 2022

View full text Add to dashboard Cite

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes a disease (COVID-19) with multisystem involvement. The world is now entering a phase of post-COVID-19 manifestations in this pandemic. Secondary hemophagocytic lymphohistiocytosis (sHLH) is a life-threatening hyperinflammatory event triggered by viral infections, including SARS-CoV-2. Both Multisystem Inflammatory Syndrome-Adults (MIS-A) and Cytokine Storm Syndrome (CSS) are considered close differentials of sHLH and add to the spectrum of Post-acute COVID-19 syndrome (PACS). In this report, we presented the case of a middle-aged Asian man who was initially discharged upon recovery from severe COVID-19 infection after 17 days of hospitalization to a private institute and later came to our hospital 13 days post-discharge. Here, he was diagnosed with sHLH, occurring as an extension of CSS, with delayed presentation falling within the spectrum of PACS. The diagnosis of sHLH was made holistically with the HLH-2004 criteria. Our patient initially responded to intravenous immunoglobulin (IVIG) and dexamethasone, later complicated by disseminated Candida auris infection and had a fatal outcome. Though many cases of HLH during active COVID-19 and a few cases post COVID-19 recovery have been reported, based on H-score, which has limitations as a diagnostic tool. We report the first case report of post-COVID-19 sHLH using the HLH-2004 criteria, complicated by disseminated Candidemia, emphasizing that the care of patients with COVID-19 does not conclude at the time of hospital discharge. We highlight the importance of surveillance in the post-COVID phase for early detection of sHLH which may predispose to fatal opportunistic infections (OIs).

show abstract

“…Elbadawi et al reported the absolute neutrophil count and not D-dimer, a traditional biomarker associated with thrombosis, is an independent predictor of thrombotic events in patients with COVID-19. 30 The mortality benefit of dexamethasone, an immunosuppressant and anti-inflammatory medication, in hospitalized patients with COVID-19 31 and recent reports of immunothrombosis 17,[32][33][34][35] and microvascular occlusion 18,[36][37][38] by multiple independent groups, suggest platelets may be indirect mediators of thrombosis and perhaps not the best direct targets for pharmacological intervention. Contemporaneous with submission of this manuscript, a smaller, nonpropensity-matched study has shown aspirin treatment decreased mortality that was driven by reduced ICU level care and mechanical ventilatory needs but not thrombosis in patients with COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Effect of aspirin on short-term outcomes in hospitalized patients with COVID-19

et al. 2021

View full text Add to dashboard Cite

Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is an ongoing viral pandemic marked by increased risk of thrombotic events. However, the role of platelets in the elevated observed thrombotic risk in COVID-19 and utility of antiplatelet agents in attenuating thrombosis is unknown. We aimed to determine if the antiplatelet effect of aspirin may mitigate risk of myocardial infarction, cerebrovascular accident, and venous thromboembolism in COVID-19. We evaluated 22,072 symptomatic patients tested for COVID-19. Propensity-matched analyses were performed to determine if treatment with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) affected thrombotic outcomes in COVID-19. Neither aspirin nor NSAIDs affected mortality in COVID-19. Thus, aspirin does not appear to prevent thrombosis and death in COVID-19. The mechanisms of thrombosis in COVID-19, therefore, appear distinct and the role of platelets as direct mediators of SARS-CoV-2-mediated thrombosis warrants further investigation.

show abstract

Case report: a fatal combination of hemophagocytic lymphohistiocytosis with extensive pulmonary microvascular damage in COVID-19 pneumonia

Cited by 8 publications

References 15 publications

A case of Hemophagocytic lymphohistiocytosis induced by COVID-19, and review of all cases reported in the literature

A case of Hemophagocytic lymphohistiocytosis induced by COVID-19, and review of all cases reported in the literature

Case Report: Secondary Hemophagocytic Lymphohistiocytosis (sHLH) and Candida auris Fungemia in Post-acute COVID-19 Syndrome: A Clinical Challenge

Effect of aspirin on short-term outcomes in hospitalized patients with COVID-19

Contact Info

Product

Resources

About