Hemophagocytic Lymphohistiocytosis Following COVID-19 Infection

Molina, Guarina; Contreras, Rafael; Coombes, Kyle; Walgamage, Thilini; Perozo, Maria A; DesBiens, Martha T

doi:10.7759/cureus.34307

Cited by 5 publications

(5 citation statements)

References 15 publications

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“…Different hematological manifestations reported worldwide include thrombocytopenia, increased D-dimer, prolonged activated partial thromboplastin (aPTT), prolonged prothrombin time (PT), low fibrinogen levels, increased serum ferritin, increased lactate dehydrogenase, arterial and venous thrombosis, elevated IL-6, and elevated CRP [ 102 , 103 ]. Sporadic case reports of inflammation related to COVID-19 infection, leading to hemophagocytic lymphohistiocytosis(HLH), have been reported [ 104 ]. Increased COVID-19-related complications and in-hospital mortality are reportedly noted in patients with higher D-dimer levels [ 102 ].…”

Section: Reviewmentioning

confidence: 99%

From Emergence to Endemicity: A Comprehensive Review of COVID-19

Naik,

Avula,

Palleti

et al. 2023

Cureus

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Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), later renamed coronavirus disease 2019 (COVID-19), was first identified in Wuhan, China, in early December 2019. Initially, the China office of the World Health Organization was informed of numerous cases of pneumonia of unidentified etiology in Wuhan, Hubei Province at the end of 2019. This would subsequently result in a global pandemic with millions of confirmed cases of COVID-19 and millions of deaths reported to the WHO. We have analyzed most of the data published since the beginning of the pandemic to compile this comprehensive review of SARS-CoV-2. We looked at the core ideas, such as the etiology, epidemiology, pathogenesis, clinical symptoms, diagnostics, histopathologic findings, consequences, therapies, and vaccines. We have also included the long-term effects and myths associated with some therapeutics of COVID-19. This study presents a comprehensive assessment of the SARS-CoV-2 virology, vaccines, medicines, and significant variants identified during the course of the pandemic. Our review article is intended to provide medical practitioners with a better understanding of the fundamental sciences, clinical treatment, and prevention of COVID-19. As of May 2023, this paper contains the most recent data made accessible.

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Section: Reviewmentioning

confidence: 99%

From Emergence to Endemicity: A Comprehensive Review of COVID-19

Naik,

Avula,

Palleti

et al. 2023

Cureus

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“…As a result, it can be inferred that the advancement of pulmonary tuberculosis played a role in the development of cryptococcal meningitis [11]. Similar associations between cryptococcal meningitis and tuberculosis have also been observed in HIV-negative individuals [12][13][14]. For hosts without an underlying compromised immune system or a transplant history, the treatment regimen comprising amphotericin B, fluconazole, and flucytosine may last six to 12 months, involving the induction, consolidation, and maintenance stages [13].…”

Section: Discussionmentioning

confidence: 82%

Cryptococcal Meningitis in an HIV-Negative Pulmonary Tuberculosis Patient: A Case Report

Naseem,

Khan,

Ali

et al. 2023

Cureus

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Cryptococcal meningitis represents a severe opportunistic fungal infection primarily observed in individuals with compromised immune systems. It frequently manifests in symptoms like headaches, vomiting, cranial nerve complications, and cognitive alterations. However, it's worth noting that up to 15% of cases may exhibit no discernible central nervous system-related symptoms. A 70-year-old male, previously diagnosed with pulmonary tuberculosis and undergoing treatment with anti-tubercular medications, was admitted due to changes in consciousness, sporadic low-grade fever, and cognitive impairment. An in-depth investigation revealed his HIV-negative and non-diabetic status, as well as his preserved immune competence. A plain CT head showed a communicating hydrocephalus and a lumbar puncture was positive for Cryptococcus neoformans. Treatment commenced with an induction regimen encompassing amphotericin and fluconazole, concurrently maintaining the anti-tubercular treatment course. The patient's condition displayed improvement, leading to a transition to a maintenance dosage of fluconazole. This case highlighted an extraordinary occurrence of Cryptococcal meningitis in an HIV-negative patient with no history of immunosuppressant use. Notably, Cryptococcal infection should be regarded as a primary consideration in patients afflicted by pulmonary tuberculosis who subsequently present with altered consciousness. The timely identification and proper management of such instances can substantially mitigate the risks of mortality and morbidity associated with this condition.

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“…The characteristics of reported cases were variant; cases were reported in adults and pediatrics patients. HLH onset post COVID-19 occurred from days to months, and COVID-19 infection severity ranged from mild to severe [17][18][19][20]. All these findings suggest that COVID-19 can trigger HLH in different scenarios, and more studies are required to further understand the link between COVID-19 and HLH.…”

Section: Discussionmentioning

confidence: 93%

X-Linked Lymphoproliferative Disease Type 2 With Activation of Hemophagocytic Lymphohistiocytosis Secondary to Epstein-Barr Virus Infection

Alsheikh,

AlSaleh

2024

Int J Clin Pediatr

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Hemophagocytic lymphohistiocytosis (HLH) is a rare yet potentially life-threatening syndrome. It is best described as uncontrolled immune system activation leading to hemophagocytosis. Our case report aims to present a practical approach, discuss the challenges in the diagnosis and management of HLH, and to shed light on the X-linked lymphoproliferative disease type 2 (XLP-2) gene, STXBP2 gene (as a carrier), and Epstein-Barr virus (EBV) infection in relation to HLH. This is a 2-year-8-month-old Saudi boy, who presented to the emergency department with fever for more than 7 days, not associated with any other major complaints. During the first couple of days of admission, primary results showed hyperferritinemia, low fibrinogen, anemia, high inflammatory markers, high D-dimer, and increasing liver enzymes and triglycerides. The patient fulfilled the diagnostic criteria of HLH on the third day of admission. Further investigations revealed a genetic mutation in XLP-2 gene, STXBP2 gene (as a carrier) and EBV infection causing HLH. HLH-94 protocol was used for management. The patient had an excellent clinical outcome, unexpectedly, by only using dexamethasone, with complete remission and no recurrence up to date. HLH is not frequently encountered in daily practice. However, it can be fatal. This case report describes a unique case of XLP-2, STXBP2 carrier with extreme EBV infection and activation of HLH, who was successfully brought into remission by partial application of HLH-94 protocol and careful clinical and laboratory monitoring. The diagnosis and management of HLH can be challenging. However, a reasonable clinical judgment can improve the outcomes.

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Hemophagocytic Lymphohistiocytosis Following COVID-19 Infection

Cited by 5 publications

References 15 publications

From Emergence to Endemicity: A Comprehensive Review of COVID-19

From Emergence to Endemicity: A Comprehensive Review of COVID-19

Cryptococcal Meningitis in an HIV-Negative Pulmonary Tuberculosis Patient: A Case Report

X-Linked Lymphoproliferative Disease Type 2 With Activation of Hemophagocytic Lymphohistiocytosis Secondary to Epstein-Barr Virus Infection

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