Hemophagocytic lymphohistiocytosis in COVID-19: Case reports of a stepwise approach.
Aged
Anti-Inflammatory Agents
/ therapeutic use
COVID-19
/ complications
Combined Modality Therapy
Critical Care
Cytokine Release Syndrome
/ drug therapy
Delayed Diagnosis
Fatal Outcome
Female
Humans
Immunoglobulin A
/ therapeutic use
Immunoglobulin M
/ therapeutic use
Immunoglobulins, Intravenous
/ therapeutic use
Immunosuppressive Agents
/ therapeutic use
Interleukin 1 Receptor Antagonist Protein
/ therapeutic use
Lymphohistiocytosis, Hemophagocytic
/ diagnosis
Male
Methylprednisolone
/ therapeutic use
Middle Aged
Respiration, Artificial
SARS-CoV-2
Journal
Medicine
ISSN: 1536-5964
Titre abrégé: Medicine (Baltimore)
Pays: United States
ID NLM: 2985248R
Informations de publication
Date de publication:
26 Mar 2021
26 Mar 2021
Historique:
received:
22
12
2020
accepted:
25
02
2021
entrez:
25
3
2021
pubmed:
26
3
2021
medline:
2
4
2021
Statut:
ppublish
Résumé
The immunologic syndrome induced by severe acute coronavirus disease 2019 (COVID-19) is yet not fully understood. Typical patterns of clinical and laboratory features match secondary hemophagocytic lymphohistiocytosis (sHLH). However, the optimal approach to COVID-19 patients testing positive for sHLH is still unclear. Three patients with COVID-19 are reviewed. All showed hyperinflammation and cytokine storm, necessitating intensive care treatment including mechanical ventilation. Secondary hemophagocytic lymphohistiocytosis due to severe COVID-19; diagnosed via HScore. A treatment regimen of methylprednisolone, pentaglobin, and anakinra was developed and administered. One patient survived the ICU stay. Two other patients, in whom sHLH was diagnosed too late, deceased. A routine screening of COVID-19 patients for secondary HLH by using the HScore is feasible; especially those patients deteriorating clinically with no sufficient response to shock management might be at particular high risk. A stepwise therapeutic approach comprising corticosteroids, immunoglobulins and anakinra, accompanied by immunoadsorption, may dampen cytokine storm effects, and potentially reduce mortality.
Identifiants
pubmed: 33761694
doi: 10.1097/MD.0000000000025170
pii: 00005792-202103260-00070
pmc: PMC9281988
doi:
Substances chimiques
Anti-Inflammatory Agents
0
Immunoglobulin A
0
Immunoglobulin M
0
Immunoglobulins, Intravenous
0
Immunosuppressive Agents
0
Interleukin 1 Receptor Antagonist Protein
0
pentaglobulin
97794-27-9
Methylprednisolone
X4W7ZR7023
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e25170Informations de copyright
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors have no conflicts of interests to disclose.
Références
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