Hemophagocytic lymphohistiocytosis in COVID-19: Case reports of a stepwise approach.
Medicine (Baltimore)
; 100(12): e25170, 2021 Mar 26.
Article
in English
| MEDLINE | ID: covidwho-1150007
ABSTRACT
RATIONALE 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. PATIENT CONCERNS Three patients with COVID-19 are reviewed. All showed hyperinflammation and cytokine storm, necessitating intensive care treatment including mechanical ventilation. DIAGNOSIS Secondary hemophagocytic lymphohistiocytosis due to severe COVID-19; diagnosed via HScore. INTERVENTIONS:
A treatment regimen of methylprednisolone, pentaglobin, and anakinra was developed and administered.OUTCOMES:
One patient survived the ICU stay. Two other patients, in whom sHLH was diagnosed too late, deceased. LESSONS 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.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Lymphohistiocytosis, Hemophagocytic
/
COVID-19
Type of study:
Case report
/
Diagnostic study
/
Prognostic study
Topics:
Long Covid
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
English
Journal:
Medicine (Baltimore)
Year:
2021
Document Type:
Article
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