Hemophagocytic Lymphohistiocytosis in a Patient With Acute Respiratory Distress Syndrome Secondary to SARS-CoV-2 Infection

Abstract

Hemophagocytic lymphohistiocytosis (HLH) is a potentially lifethreatening entity resulting from the dysregulated activation of Tlymphocytes. Secondary HLH (sHLH) complicates various medical conditions. Similar to 2009 H1N1 influenza, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection appears to trigger a cytokine storm in a subset of individuals. The patient of 64 years old presented himself in the emergency department with cough and fever, and was subjected to the nasopharyngeal swab and tested positive for SARS-CoV-2, as expected from epidemiological data. Hospitalized in cohort isolation, he initially presented a multi-organ impairment and specifically a worsening of his renal function, initial coagulopathy, lymphopenia modest thrombocytopenia and systemic inflammatory commitment. During the course of the 6th day, a picture of a probable cytokine storm and clear multiple organ failure (MOF) was evident. Therefore a clinical diagnosis was made according to HScore criteria of secondary hemophagocytic lymphohistiocytosis. We started high-dose steroid therapy (dexamethasone 8 mg bid). And after 36 h, the patient was significantly improved: alert, oriented, weaned from non-invasive ventilation (NIV) and stable blood chemistry. In conclusion, in coronavirus disease 2019 (COVID-19) positive patients with evidence of cytokine storm and acute respiratory distress syndrome (ARDS), the levels of blood triglycerides and ferritin are useful and often decisive to comfort the diagnosis of sHLH if cytopenia of one or more lines is revealed.

Evaluation of Outcome in Patients With Moderate and Severe COVID-19 Via H-Score

“…The utility of the H-score in the COVID-19 setting has been controversial. Some studies suggest the utilization of the H-score as diagnostic criteria for sHLH in CO-VID-19 patients, while some studies propose H-score as a tool for predicting the outcome of COVID-19 patients [16][17][18]. Organomegaly, hypofibrinogenemia, and cytopenia are common features among HLH patients, while COVID-19 patients mostly present with hyperfibrinogenemia, leukocytosis, and no sign of organomegaly.…”

Epidemiological and Clinical Profile of COVID-19 in Nepali Children: An Initial Experience

“…Children reported with COVID-19 were classified into one of the following categories: 7 • Asymptomatic infection: without any clinical symptoms and signs Table 2. Clinical characteristics of the study population This study highlighted that majority of paediatric patients diagnosed with COVID-19 were identified through contact investigation or community tracing.…”

Neonatal COVID and Familial Hemophagocytic Lymphohistiocytosis

“…9 Cytopenia, lymphopenia, and HLH associations have been reported with coronavirus infection in adults. 7,[10][11][12] However, there has been no such association of "neonatal 1). Cytokine release syndrome refers to a form of systemic inflammatory response syndrome (SIRS) that can be triggered by infections or certain drugs.…”

“…The second controversy is whether coronavirus infection can trigger onset of cytopenia and hemophagocytosis associated with familial HLH and UNC13D mutations 9 . Cytopenia, lymphopenia, and HLH associations have been reported with coronavirus infection in adults 7,10–12 . However, there has been no such association of “neonatal COVID” and “familial HLH” reported for “COVID hemophagocytosis syndrome” or “COVID HLH syndrome.”…”