COVID-19 vaccination–related hemophagocytic lymphohistiocytosis presenting as acute liver failure

Awan, Rehmat Ullah; Rashid, Shazia; Nabeel, Ambreen; Samant, Hrishikesh

doi:10.1080/08998280.2022.2123665

Cited by 3 publications

(4 citation statements)

References 16 publications

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“…The entry of the SARS-COV-2 virus into the respiratory epithelial cell triggers a pathway resulting in the infiltration of macrophages and neutrophils into the lung tissue. This results in a systemic pro-inflammatory state causing end-organ damage and subsequent multi-organ failure [16,17]. The exact mechanism by which SARS-COV-2 causes gastrointestinal symptoms like diarrhea is still poorly understood, though it likely involves malabsorption, increased permeability of the luminal mucosa, and gut dysbiosis [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Outcomes in Inflammatory Bowel Disease Hospitalized Patients: A Comprehensive Analysis Using the National Inpatient Sample

Joseph,

Akhlaq,

Awan

et al. 2023

Gastroenterol Res

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Background There is no uniformity in the available literature concerning the effects of coronavirus disease 2019 (COVID-19) viral illness on people with inflammatory bowel disease (IBD). Methods We conducted an analysis using the 2020 National Inpatient Sample (NIS) database to compare the outcomes of COVID-19 hospitalized patients with and without IBD. Results Of 1,050,040 patients admitted with COVID-19, 5,750 (0.5%) also had IBD. The group with COVID-19 and IBD had higher percentages of females and White individuals and a greater prevalence of chronic lung disease, peripheral vascular disease, and liver disease. However, after accounting for confounding variables, there was no significant difference in mortality rates, length of hospital stays, or hospitalization costs between the two groups. Conclusion According to our findings, the presence of IBD does not appear to elevate the risk of COVID-19 complications.

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Section: Discussionmentioning

confidence: 99%

COVID-19 Outcomes in Inflammatory Bowel Disease Hospitalized Patients: A Comprehensive Analysis Using the National Inpatient Sample

Joseph,

Akhlaq,

Awan

et al. 2023

Gastroenterol Res

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“…However, acute liver failure developed and etoposide was discontinued with an unfavourable outcome. 34 Mortality among adult patients with HLH ranges from 42% to 88%, while mortality among reported patients with secondary HLH induced by COVID-19 vaccine was 22% (4/18 patients). [24][25][26][27][28][29][30][31][32][33][34] The pathophysiological mechanism beneath sHLH development after vaccination is not fully understood.…”

Section: Dovepressmentioning

confidence: 99%

“…34 Mortality among adult patients with HLH ranges from 42% to 88%, while mortality among reported patients with secondary HLH induced by COVID-19 vaccine was 22% (4/18 patients). [24][25][26][27][28][29][30][31][32][33][34] The pathophysiological mechanism beneath sHLH development after vaccination is not fully understood. HLH is caused by a positive feedback loop between macrophages, activated CD8+ T cells and antigen-presenting cells.…”

Section: Dovepressmentioning

confidence: 99%

Acute Liver Failure Caused by Secondary Hemophagocytic Lymphohistiocytosis After COVID-19 Vaccination – Case Report and Literature Review

Premec,

Živko,

Mijić

et al. 2023

IMCRJ

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Hemophagocytic lymphohistiocytosis (HLH) is a congenital or acquired hyperinflammatory syndrome, in some cases accompanied by acute liver failure. We present a case report of acute liver failure associated with HLH after COVID-19 vaccination and bring a literature review of the connection between HLH and COVID-19 vaccination. HLH has significant mortality rate, and liver transplantation is not a therapeutic option. Therefore, early recognition and timely conservative treatment are corner stones in reducing HLH-related morbidity and mortality.

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“…As a result, delayed diagnosis of HLH with neurological manifestations is common, resulting in a poor prognosis. In this case report, we described a woman with secondary HLH with neurological manifestations following Coronavirus disease 2019 (COVID- 19) vaccination with the Oxford Astra-Zeneca ® ChAdOx1 nCoV-19 vaccine.…”

Section: Introductionmentioning

confidence: 99%

Probable secondary hemophagocytic lymphohistiocytosis manifesting as central nervous system lesions after COVID-19 vaccination: a case report

Kim,

Chung,

Bong

2024

Front. Neurol.

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BackgroundHemophagocytic lymphohistiocytosis (HLH) is a rare systemic inflammatory disease commonly characterized by histiocyte infiltration in multiple organs, such as the liver, spleen, lymph nodes, bone marrow, and central nervous system. The clinical features of HLH include fever, splenomegaly, cytopenia, hypertriglyceridemia, hypofibrinogenemia, and elevated blood ferritin levels. HLH is categorized as either primary or secondary. Coronavirus disease 2019 (COVID-19) vaccines may occasionally trigger secondary HLH, which is related to hyperinflammatory syndrome.Case presentationA 58-year-old woman, previously diagnosed with Graves’ disease, presented with cognitive decline 2 weeks after receiving the first dose of the ChAdOx1 nCoV-19 vaccine. Brain MRI revealed a hyperintense lesion on T2-weighted and fluid-attenuated inversion recovery images in the bilateral subcortical white matter and right periventricular area. Vaccination-associated acute disseminated encephalomyelitis was suspected and methylprednisolone and intravenous immunoglobulin (IVIg) were administered. From the 5th day of IVIg administration, the patient developed fever and pancytopenia. In the findings of bone marrow biopsy, hemophagocytosis was not observed; however, six of the eight diagnostic criteria for HLH-2004 were met, raising the possibility of HLH. Although there was no definitive method to confirm causality, considering the temporal sequence, suspicion arose regarding vaccine-induced HLH. Splenectomy was considered for therapeutic and diagnostic purposes; however, the patient died on the 28th day of hospitalization owing to multiple organ failure.ConclusionTo date, 23 cases of COVID-19 vaccine-related HLH have been reported. Additionally, HLH in COVID-19 patients has been reported in various case reports. To the best of our knowledge, this is the first reported case of central nervous system involvement in HLH related to any type of COVID-19 vaccine. This case suggests that even when there are no systemic symptoms after COVID-19 vaccination, HLH should be considered as a differential diagnosis if brain lesions are suggestive of CNS demyelinating disease.

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COVID-19 vaccination–related hemophagocytic lymphohistiocytosis presenting as acute liver failure

Cited by 3 publications

References 16 publications

COVID-19 Outcomes in Inflammatory Bowel Disease Hospitalized Patients: A Comprehensive Analysis Using the National Inpatient Sample

COVID-19 Outcomes in Inflammatory Bowel Disease Hospitalized Patients: A Comprehensive Analysis Using the National Inpatient Sample

Acute Liver Failure Caused by Secondary Hemophagocytic Lymphohistiocytosis After COVID-19 Vaccination – Case Report and Literature Review

Probable secondary hemophagocytic lymphohistiocytosis manifesting as central nervous system lesions after COVID-19 vaccination: a case report

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