Gestational Psittacosis With Secondary Hemophagocytic Syndrome: A Case Report and Literature Review

Abstract

Gestational psittacosis and hemophagocytic syndrome (HPS) are rare clinical diseases. In this article, a case of gestational psittacosis concomitant with secondary HPS was reported. An analysis was performed on the clinical characteristics, signs, laboratory findings, progression, diagnosis, and treatment of a patient with gestational psittacosis concomitant with secondary HPS. Besides, the literature with respect to this disease was reviewed. This patient was definitively diagnosed through metagenomic next-generation sequencing techniques, bone marrow puncture and smear examination, and the determination of sCD25 level and natural killer (NK) cell activity. Anti-infectives such as doxycycline and etoposide combined with hormone chemotherapy achieved significant improvement in cough and expectoration, a return to normal temperature, and a significant improvement in oxygenation index. In addition, chest computed tomography revealed obvious absorption of lung lesions and a return of NK cell activity and sCD25 levels to normal ranges. Chlamydia psittaci pneumonia requires a clear determination of etiology, while HPS requires bone marrow puncture and smear examination, together with the determination of sCD25 level and NK cell activity in the blood. The findings of this study suggest that metagenomic next-generation sequencing is an effective instrument in clearly identifying pathogens that cause lung infection. Clinicians should consider atypical pathogens of lung infection in patients with poor response to empirical anti-infectives, and strive to design an effective treatment strategy as per an accurate diagnosis based on the etiology. As for patients suffering from long-term high fever and poor temperature control after broad-spectrum antibiotic treatment, non-infectious fever should be taken into account. A rapid and clear diagnosis would significantly improve patient prognosis.

Gestational psittacosis causes severe pneumonia and miscarriage: A case report and literature review

“…Psittacosis patients can present clinically in a variety of ways, such as subclinical illness or flu-like symptoms (mild parrot fever), pneumonia (moderate parrot fever), severe pneumonia (severe parrot fever), or severe pneumonia coupled with multiple organ dysfunction syndrome (fulminant parrot fever) [15] . These clinical signs are similar with recent reports of prenatal psittacosis as well as our case, with 1 patient developing hemophilic syndrome, which ultimately led to maternal and fetal mortality [16] , [17] . As the illness advanced, the patient's shortness of breath, cough, serious pneumonia, and multiorgan failure appeared.…”

Tuberculosis infection related hemophagocytic lymphohistiocytosis diagnosed in patient with GZMB mutation: A case report and literature review

“…In our review of literature, by the end of April 2022, 9 cases of infection related HLH applying mNGS to identify underlying pathogenic microorganisms have been published (Table 3), [18][19][20][21][22][23][24][25][26] our case is listed in the table as well. The age of patients range from 4-month-old to 49 years old, and their median age is 31 years old.…”

“…Lin Z, et al [23] 7 2021 27y/F Pregnancy peripheral blood, alveolar lavage fluid Chlamydia psittaci Not covered Sun L, Li P, et al [24] 8 2022 33y/M plasma Toxoplasma gondii Positive (antibody) Zhou Y, et al [25] 9 2022 35y/M peripheral blood Severe fever with thrombocytopenia syndrome virus Not covered Zhu T, et al [26] This case 2019 29y/M peripheral blood Mycobacterium tuberculosis Negative (culture, antibody)…”

病理解剖することで診断に至った妊娠オウム病の1例(Postmortem diagnosis of gestational psittacosis: a case report)

“…オウム病は Chlamydia psittaci （ C. psittaci ）が経気道的に侵入して起きる呼吸器感染症である。一般に軽症例が多いが，妊婦においてまれに妊娠オウム病と呼ばれる重症例がみられ 1), 2), 3), 4), 5), 6), 7), 8), 9)，診断の難しさから原因不明のまま死亡する例が潜在的に存在すると考えられる。今回，敗血症による急激な経過で死亡し，病理解剖によって妊娠オウム病と診断した1例を経験し，妊娠オウム病における診断と病理解剖に至る経過について示唆を与えるため報告する。…”