Coronavirus Does It Again: Post-COVID-19 Hemophagocytic Lymphohistiocytosis (HLH)

Abstract

Hemophagocytic lymphohistiocytosis (HLH) is a hematological disorder that results from an uncontrolled activation of the immune system, which can then lead to multisystem organ failure. Given the nonspecific nature of this illness, it can go undetected for too long, thereby causing permanent damage to organ systems. In adults, HLH has been associated with a number of infectious etiologies, particularly viral infections. Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a global pandemic and has been associated with acute respiratory distress syndrome (ARDS). Among its other manifestations, COVID-19 has also been linked to HLH. In this report, we describe a case of a male patient who presented with multisystem organ failure and was found to have HLH. Since no clear etiology for his HLH could be elicited, it was determined to be a result of his recent COVID-19 infection.

Acute Heart Failure in the Course of Macrophage Activation Syndrome Due to Newly Diagnosed Systemic Lupus Erythematosus: Case Presentation and Literature Review

“…It may be a useful tool for screening, especially in patients with hepato- and splenomegaly, progressive cytopenia, and subacute fever occurring alongside SARS-CoV-2 infection [ 20 ]. Moreover, there is a growing number of case reports of patients developing MAS even several months after COVID-19 infection, which suggests that looking for this aetiologic factor in patients’ recent history may explain the occurrence of MAS in individuals with no autoimmune comorbidities [ 21 , 22 ].…”

Paediatric Hemophagocytic Lymphohistiocytosis: A Case Series With a Diverse Spectrum From a Resource-Limited Setting

“…Although the entity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated HLH is not very common as of now, it is evident that a systemic hyper-inflammatory state plays an important role in multi-organ dysfunction and Kawasaki disease-like presentation [7]. There are a few recent case reports in adults where SARS-CoV-2 was attributed as a cause of HLH [8,9]. There are a few case reports in the pediatric population too where SARS-CoV-2 was associated with HLH [10].…”

SARS-CoV2 is not just infection but a culprit of donor graft failure post-allogeneic stem cell transplant

“… 25,29,30 At the initial phase of the severe infectious stage of SARS-CoV2, it is difficult to attribute inflammatory reactions solely to HLH versus SARS-CoV2 infection without other evidence, especially from BM biopsy. 31 Therefore, conclusive pathophysiology behind post- SARS-CoV2 HLH is yet to be found. 31 …”