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

Abstract

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).

Post-COVID-19 Spondylodiscitis: A Case Study and Review of the Literature

“…Persistent or recurrent staphylococcal bacteriaemia related to SD in the COVID-19 pandemic has been reported in other cases of young healthy patients and unapparent infectious foci, speculated to be accounted to the immune disfunction, with secondary (reactive) hemophagocytic lymphohistiocytosis and to the diffuse vascular damages [ 32 , 33 , 34 , 35 ]. The first line of anti-staphylococcal antibiotics aimed highly antibiotic resistant MRSA but resulted in incompletely recovery after six weeks.…”

Nanotechnology-Based Strategies to Combat Multidrug-Resistant Candida auris Infections

“…Infections with C. auris have been documented in 45 nations in Far East Asia, the Middle East, Africa, Europe, North America and South America, demonstrating its worrying rapid evolution worldwide [ 9 ]. Moreover, many clinical reports demonstrated that C. auris outbreaks are linked to the COVID-19 pandemic [ 41 , 42 , 43 , 44 , 45 , 46 ].…”

Clinical Challenges of Emerging and Re-Emerging Yeast Infections in the Context of the COVID-19 Pandemic

“…More studies of these cases are needed to formulate strategies for the diagnosis and management of these novel post-COVID-19 conditions. Meta-analysis studies showed an estimated global prevalence of 5.7% in patients with severe COVID-19 and mortality was estimated at 68% [72].…”