Fatal Gets More Fatal: A COVID-19 Infection With Macrophage Activation Syndrome

Abstract

Coronavirus disease 2019 (COVID-19) continues to be fatal despite advances in the understanding of characteristics of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), global prevention strategies, new anti-viral treatments, and worldwide vaccination programs. The exact underlying mechanism through which SARS-CoV-2 leads to acute respiratory distress syndrome (ARDS) resulting in intensive care unit admission, mechanical ventilation, and eventually death remains elusive. Cytokine storm is one of the most favorable mechanisms that scientists show remarkable interest to target in randomized clinical trials with promising outcomes. Macrophage activation syndrome (MAS), the most serious form of cytokine storm, requires early recognition and treatment regardless of etiology. Here, we report a 59-year-old gentleman with a COVID-19 infection complicated by MAS. Our aim is to increase awareness of this condition among health care providers as it necessitates prompt diagnosis and treatment due to an extremely poor prognosis.

Macrophage phagocytosis of SARS-CoV-2-infected cells mediates potent plasmacytoid dendritic cell activation

“…Importantly, macrophages are one of the main sources of proinflammatory cytokines such as IL-6 and TNF and were found to play a central role in the pathology of severe COVID-19 [ 7 , 8 ]. Indeed, one of the most threatening forms of COVID-19 has been termed “macrophage activation syndrome” [ 9 ].…”

Post COVID immune phenomena: Expanded role of the Nephrologist

“…Proposed mechanisms of COVID induced thrombocytopenia include inhibition of platelet synthesis due to direct infection of the bone marrow cells or platelets by the virus, virus-mediated liver damage leading to decreased thrombopoietin production, pulmonary endothelial damage followed by platelet aggregation and consumption in the lungs, and an immune mediated destruction [12] . Macrophage activation syndrome (MAS) following COVID has been described in a few cases and is frequently associated with and presents concomitantly with COVID pneumonia [13,14] . Delayed presentation after recovery from COVID pneumonia has also been described [13] .…”

“…Macrophage activation syndrome (MAS) following COVID has been described in a few cases and is frequently associated with and presents concomitantly with COVID pneumonia [13,14] . Delayed presentation after recovery from COVID pneumonia has also been described [13] . Isolated refractory thrombocytopenia may be an early clue to the development of macrophage activation syndrome, in the appropriate clinical context [15] .…”

sMR and PTX3 levels associate with COVID-19 outcome and survival but not with Long COVID

“… 14 , 15 , 16 Furthermore, COVID-19 has features reminiscent of macrophage activation syndrome (MAS). 17 , 18 When these aforementioned pathologies are not treated adequately during the acute phase of the disease, possible tissue hypoxia and reduced oxygen exchange can linger for months and may therefore be responsible for the onset of Long COVID. 5 , 19 …”