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Hyperinflammation with COVID-19: The key to patient deterioration?
Haigh, Kathryn; Syrimi, Zoe Joanna; Irvine, Sharon; Blanchard, Tom J; Pervaiz, Muhammad Sajid; Toth, Arpad G; Ratcliffe, Libuse.
  • Haigh K; Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, United Kingdom.
  • Syrimi ZJ; Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, United Kingdom.
  • Irvine S; Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, United Kingdom.
  • Blanchard TJ; Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, United Kingdom.
  • Pervaiz MS; Department of Haematology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom.
  • Toth AG; Department of Haematology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom.
  • Ratcliffe L; Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, United Kingdom.
Clin Infect Pract ; 7: 100033, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-343694
Semantic information from SemMedBD (by NLM)
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ABSTRACT

BACKGROUND:

The potential risk of cytokine storm in patients with coronavirus disease 2019 (COVID-19) has been described [1]; we write to share our experience treating a 17-year-old male with haemophagocytic lymphohistiocytosis (HLH) secondary to COVID-19 infection. CASE REPORT This patient presented with cough, sore throat, anorexia and pyrexia. On examination, he had gross cervical lymphadenopathy and palpable splenomegaly. Nose and throat swab for SARS-CoV-2 was positive and blood tests revealed pancytopaenia with very high ferritin, triglyceride and d-dimer levels. The patient's H-Score [2] was calculated at 220, suggesting probability of HLH of 93-96%. Considering Russell and colleagues' [3] comments about potential harm of corticosteroid use in patients with COVID-19 infection, the patient was commenced on treatment with the selective IL-1 receptor antagonist drug, Anakinra, and a two-day course of intravenous immunoglobulin.

RESULTS:

The patient responded rapidly to treatment, becoming apyrexial after 24 h. His lymph nodes and spleen began to normalise after the first 48 h, at which time point the ferritin also started to decrease. He was discharged after 11 days feeling fit and well.

CONCLUSION:

This case certainly illustrates the importance of hyperinflammation syndromes in COVID-19. It also raises the question - is the severe pneumonitis seen in patients with COVID-19 an immunological phenomenon? We know that the viral load of patients with COVID-19 seems to peak in the early stages of illness [4,5]; however, patients deteriorate later in the disease course, at around days 10-14. This patient, who had risk factors for deterioration (male, pancytopaenic), did not develop an oxygen requirement and clinically and biochemically improved rapidly on Anakinra with no adverse events. We might suggest Anakinra to the scientific community as a treatment option in COVID-19 infection.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Experimental Studies / Prognostic study Language: English Journal: Clin Infect Pract Year: 2020 Document Type: Article Affiliation country: J.clinpr.2020.100033

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Experimental Studies / Prognostic study Language: English Journal: Clin Infect Pract Year: 2020 Document Type: Article Affiliation country: J.clinpr.2020.100033