RESUMEN
There have been a small number of cases of scrub typhus-associated hemophagocytic syndrome (HPS), most of which were treated successfully using adequate antibiotics. Here, we report a case of Epstein-Barr virus (EBV)-associated HPS after scrub typhus infection that was not improved using antirickettsial treatment. A 73-year-old male who had been diagnosed with scrub typhus according to an eschar and a positive serology was transferred to our institution because of a persistent fever despite 7-day doxycycline therapy. Physical and laboratory data showed hepatosplenomegaly, bicytopenia, hyperferritinemia, and hypofibrinogenemia. A bone marrow examination (BM) revealed hypercellular marrow with hemophagocytosis and histiocyte infiltration. EBV was detected in BM aspirates using polymerase chain reaction. After a diagnosis of HPS was made, the patient was treated successfully using high-dose steroids.
Asunto(s)
Anciano , Humanos , Masculino , Antibacterianos , Médula Ósea , Examen de la Médula Ósea , Diagnóstico , Doxiciclina , Infecciones por Virus de Epstein-Barr , Fiebre , Herpesvirus Humano 4 , Histiocitos , Linfohistiocitosis Hemofagocítica , Reacción en Cadena de la Polimerasa , Tifus por Ácaros , EsteroidesRESUMEN
BACKGROUND/AIMS: Primary non-ampullary duodenal adenocarcinomas (PNADAs) comprise or =2 mg/dL (OR, 85.28; 95% CI, 3.77-1,938.79; p=0.005) and distant metastasis (OR, 26.74; 95% CI, 3.13-2,328.14; p=0.003) at the time of diagnosis were independent poor prognostic factors. CONCLUSIONS: The majority of patients were diagnosed at an advanced stage. Presence of distant metastasis was independent prognostic factor of PNADA together with elevated total bilirubin.