Secondary haemophagocytic lymphohistiocytosis associated with metronidazole

Iio, Kazuki; Ariyama, Yuta; Tomita, Hirofumi; Sakakibara, Hiroshi; Hataya, Hiroshi

doi:10.1136/postgradmedj-2019-136512

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…Clinical patterns range between signs and symptoms of sepsis, SIRS, shock and multi-organ failure [2]. Diagnosis is confirmed when at least 5 out of 8 criteria are met [3]: (1) fever; (2) Splenomegaly; (3) Cytopenias affecting 2 of 3 lineages in the peripheral blood: a) hemoglobin less than 90 g/L or less than 100 g/L in infants < 4 weeks; b) Platelets less than 100 x10 9 /L; c) Neutrophils less than 1.0 x 10 9 /L; (4) Hypertriglyceridemia and/or hypofibrinogenemia; (5) Hemophagocytosis in bone marrow, spleen or lymph nodes; (6) Low or absent NK-cell activity; (7) Ferritin greater than 500 ug/L; (8) Soluble IL-2 receptor (CD25) greater than 2400 U/mL. The treatment consists in a first step of trigger eradication (i.e., an underlying infectious agent) and then reducing the lymphocytes activation (steroids, etoposide, anti-T-cell agents, as well as new biologic treatments, and eventually allogenic stem cell transplantation).…”

Section: Introductionmentioning

confidence: 99%

“…HLH can be primary (related to particular kinds of genes and immunodeficiencies), either secondary to infections (with the most common agent be the Epstein-Barr virus) or rheumatologic conditions (namely MAS: Macrophage Activation Syndrome). Other described potential triggers to be mentioned are medications, surgery, and during this last period, the COVID-19 agent [4][5][6][7][8][9][10][11]. In fact, the recently defined Pediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS) is a life-threating disease affecting children, likely related to some COVID-19 exposure and close resembling HLH and/or MAS [5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…Other described potential triggers to be mentioned are medications, surgery, and during this last period, the COVID-19 agent [4][5][6][7][8][9][10][11]. In fact, the recently defined Pediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS) is a life-threating disease affecting children, likely related to some COVID-19 exposure and close resembling HLH and/or MAS [5][6][7][8][9][10][11]. Additionally, PIMS-TS may share some clinical features with Kawasaki disease, even the two entities distinctly differ.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

9-day high-grade spiking postoperative fever in a child with acute appendicitis: facing clinical systemic disorders in surgery setting

Ugolini¹,

Rosati²,

Coletta³

et al. 2021

Case Rep Imag Surg

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When dealing with a postoperative persistent fever in a surgical patient, multisystemic inflammatory disorders must be kept in mind, recognized at an early stage and suddenly managed multidisciplinary. We report about a life-threatening condition which was unlikely to be seen in a surgical context before the pandemic: the newly defined "Pediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 infection" (PIMS) is suspected when a patient presents with consistent clinical features; In the 78% of patients, some COVID19 exposure can be documented. A paediatric case of hemophagocytic lymphohistiocytosis is reported (eventually falling into the PIMS entity), follo by a laparoscopic appendectomy for an acute gangrenous appendicitis. An alert to the community of pediatric surgeons is warranted, hopefully to be a hands-on update within the 2020 pandemic.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

9-day high-grade spiking postoperative fever in a child with acute appendicitis: facing clinical systemic disorders in surgery setting

Ugolini¹,

Rosati²,

Coletta³

et al. 2021

Case Rep Imag Surg

View full text Add to dashboard Cite

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Metronidazole

2019

Reactions Weekly

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Metronidazole Induced Cutaneous Adverse Drug Reaction- A Systematic Review of Descriptive Studies

Taj,

Zuber,

Hanumanthaiah

et al. 2024

CRCEP

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Background: A substantial number of research studies on metronidazole-related cutaneous symptoms have recently been published. Our objective was to identify and evaluate descriptive studies that described metronidazole-related skin manifestations, therapeutic interventions, and consequences. Methodology: A comprehensive literature search was carried out in the PubMed, Scopus, and grey literature databases from inception to April 2022 without any constraints, as well as a snowball search in Google and a search in Google Scholar. Descriptive articles describing metronidazole-related cutaneous manifestations were considered for the review. Two distinct reviewers carried out the research selection, data extraction, and quality assessment; any discrepancies were resolved by consensus with the third reviewer. Results: About 24 out of 4648 descriptive studies, including 26 patients (20 Female patients and 6 male patients), were included in this review. The included studies comprised a range of ages from 16 to 78 years old. Metronidazole was indicated for the treatment of bacterial vaginosis, trichomoniasis, sepsis, anti-infection therapy, perforated appendicitis, rosacea, vaginal discharge, dysentery, acne rosacea, trichomonal vaginitis, lichen planus, liver abscess, facial rosacea, intestinal amoebiasis, and gingivitis. Fixed drug eruption was the most common skin manifestation which was reported in 7 cases included in this review. Cutaneous manifestations were ameliorated by cessation of the offending drug and by apportioning antihistamines, topical steroids, parenteral corticosteroids, emollients, and topical moisturizers. Conclusion: Clinicians and healthcare professionals should be cognizant of the potential cutaneous adverse drug reactions (CADRs) induced by metronidazole to mitigate fatal circumstances. The management of the CADRs appears to respond effectively with immediate drug discontinuation and supportive therapy.

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Secondary haemophagocytic lymphohistiocytosis associated with metronidazole

Cited by 3 publications

References 5 publications

9-day high-grade spiking postoperative fever in a child with acute appendicitis: facing clinical systemic disorders in surgery setting

9-day high-grade spiking postoperative fever in a child with acute appendicitis: facing clinical systemic disorders in surgery setting

Metronidazole

Metronidazole Induced Cutaneous Adverse Drug Reaction- A Systematic Review of Descriptive Studies

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