Fulminant Epstein–Barr virus‐associated hemophagocytic syndrome in a renal transplant patient and review of the literature

Romiopoulos, Iordanis; Pyrpasopoulou, Athina; Onoufriadis, I.; Massa, E.; Mouloudi, Eleni; Kydona, C.; Giasnetsova, T.; Gerogianni, N.; Myserlis, G.; Solonaki, F.; Nikodimopoulou, M.; Μανδαλά, Ευδοκία; Antachopoulos, Charalampos; Roilides, Emmanuel

doi:10.1111/tid.12586

Cited by 6 publications

(4 citation statements)

References 28 publications

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“…For the first time, we report a case of a rapid clinical recovery following rituximab and dexamethasone in a critically ill kidney transplant patient with likely COVID-19-driven EBV reactivation and features of secondary HLH. Secondary HLH is a rare but well-established complication of renal transplantation, triggered mostly by infections (in particular, viral such as EBV or CMV) or malignancy [ 1 ]. This life-threatening hyper-inflammatory condition is characterised by fever, (hepato) splenomegaly and cytopenias due to unregulated activation of cytotoxic T cells, NK cells and macrophages.…”

Section: Discussionmentioning

confidence: 99%

Use of rituximab in SARS-CoV-2-positive renal transplant recipient with EBV reactivation and probable haemophagocytic lymphohistiocytosis

et al. 2022

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We present a case of a rapid clinical recovery in a critically ill kidney transplant recipient with SARS-CoV-2 positivity, Epstein–Barr virus (EBV) reactivation and probable secondary hemophagocytic lymphohistiocytosis (HLH) treated with etoposide-free regimen, based on dexamethasone and a single dose of rituximab. Although rituximab is often a part of EBV-HLH treatment strategy, its use in simultaneous Coronavirus 2019 disease (COVID-19) and solid-organ transplantation has not been reported yet. We review the current evidence for the potential of SARS-CoV-2 to trigger EBV reactivation, leading to a severe clinical illness. Finally, we compare the clinical features of hyper-inflammatory response typical for severe COVID-19 and classical secondary HLH and discuss the benefits of therapeutic B-cell depletion in both conditions.

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Section: Discussionmentioning

confidence: 99%

Use of rituximab in SARS-CoV-2-positive renal transplant recipient with EBV reactivation and probable haemophagocytic lymphohistiocytosis

et al. 2022

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“…Since 1979, 21 cases of CMV-associated HLH in kidney transplant recipients were reported in the literature [8]. In the majority of cases, HLH occurred within 1 and 6 months after transplantation, and it represented a reactivation of a latent disease.…”

Section: Discussionmentioning

confidence: 99%

“…In the majority of cases, HLH occurred within 1 and 6 months after transplantation, and it represented a reactivation of a latent disease. Mortality was reported in 9 out of 21 cases (42.8%) [8]. For cases with an available detailed medical history, progression to lethal outcome was quite rapid, ranging from 9 to 21 days.…”

Section: Discussionmentioning

confidence: 99%

Unusual Presentation of Hemophagocytic Lymphohistiocytosis in a Kidney Transplant Patient

Yang

Thamcharoen

Marcus

et al. 2019

Case Reports in Transplantation

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We are presenting a case of a middle-aged woman with history of remote kidney transplantation who had multiple admissions for septic shock-like picture, recurrent fever, and hypotension. Her shock manifestation would resolve after stress dose steroid administration and less than 24 hours of vasopressor administration. Initially, extensive workup was performed without revealing etiology. Eventually, a bone marrow biopsy was carried out leading to the diagnosis of hemophagocytic lymphohistiocytosis, most likely related to recent cytomegalovirus infection.

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“…In addition, rhabdomyolysis is recurrently associated with EBV-induced AKI and should be identified in these situations [ 171 ]. Hemophagocytic syndrome is a rare but dramatic complication of EBV infection caused by a cytokine storm that can lead to severe AKI [ 172 , 173 ]. Finally, some cases of glomerulonephritis and thrombotic microangiopathy have also been reported in the setting of primary EBV infection [ 171 , 174 , 175 ].…”

Section: The Herpesviridae Familymentioning

confidence: 99%

Virus-Associated Nephropathies: A Narrative Review

Masset

Turnier

Bressollette-Bodin

et al. 2022

IJMS

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While most viral infections cause mild symptoms and a spontaneous favorable resolution, some can lead to severe or protracted manifestations, specifically in immunocompromised hosts. Kidney injuries related to viral infections may have multiple causes related to the infection severity, drug toxicity or direct or indirect viral-associated nephropathy. We review here the described virus-associated nephropathies in order to guide diagnosis strategies and treatments in cases of acute kidney injury (AKI) occurring concomitantly with a viral infection. The occurrence of virus-associated nephropathy depends on multiple factors: the local epidemiology of the virus, its ability to infect renal cells and the patient’s underlying immune response, which varies with the state of immunosuppression. Clear comprehension of pathophysiological mechanisms associated with a summary of described direct and indirect injuries should help physicians to diagnose and treat viral associated nephropathies.

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Fulminant Epstein–Barr virus‐associated hemophagocytic syndrome in a renal transplant patient and review of the literature

Cited by 6 publications

References 28 publications

Use of rituximab in SARS-CoV-2-positive renal transplant recipient with EBV reactivation and probable haemophagocytic lymphohistiocytosis

Use of rituximab in SARS-CoV-2-positive renal transplant recipient with EBV reactivation and probable haemophagocytic lymphohistiocytosis

Unusual Presentation of Hemophagocytic Lymphohistiocytosis in a Kidney Transplant Patient

Virus-Associated Nephropathies: A Narrative Review

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