Hemophagocytic syndrome in patients infected with the human immunodeficiency virus: A study of 15 consecutive patients

Abstract

Objectives. Hemophagocytic syndrome (HPS) is characterized by various clinical and biological data derived from cytokine hyperproduction and cell proliferation. The objectives of this study were to evaluate the epidemiological, etiological, clinical and evolutionary characteristics of patients diagnosed with hemophagocytic syndrome and HIV infection, as well as their comparison with data from the literature. Methods. A retrospective descriptive observational study was performed, including all adult patients with a diagnosis of HPS and HIV infection treated in the Infectious Diseases and Tropical Medicine Unit of the Hospital Universitario Insular, Las Palmas, Gran Canaria from June 1, 1998 to December 31, 2018. Results. An analysis of this series of case reports of 15 patients showed a higher percentage of males than females, with a mean age of 42 years. With respect to the diagnostic criteria for HPS, presence of fever, cytopenias and hyperferritinemia were a constant in all patients. Clinical neurological manifestations were frequent and clinical respiratory signs and symptoms absent. HPS was confirmed in some patients who were not severely immune-depressed and had undetectable viral loads. Furthermore, 40% of cases were not receiving ART. The most frequent triggering causes of HPS were viral, especially HHV-8. In addition, two new HPS triggers were identified: Blastocystis dermatitidis and Mycobacterium chelonae. Conclusion. Administration of treatment in HPS is arbitrary. This, together with the high mortality rate and the fact that it is underdiagnosed, indicates the importance of conducting future studies.

An Unusual Case of Hemophagocytic Lymphohistiocytosis Presentation in Acute Human Immunodeficiency Virus

“… 7 - 10 The most frequent malignancies associated with HLH are lymphoma, and related autoimmune diseases such as systemic lupus erythematosus and adults Still’s disease. 11 …”

Hemophagocytic Lymphohistiocytosis and Infection: A Literature Review

“…Four other studies tried to evaluate the association between HIV and HLH [24][25][26][27]. A large study with 3066 patients with HIV noticed that the most common symptoms in immunocompromised patients with HLH were fever, cytopenias, and elevated ferritin.…”

“…A large study with 3066 patients with HIV noticed that the most common symptoms in immunocompromised patients with HLH were fever, cytopenias, and elevated ferritin. In contrast, 33% of the patients presented CNS involvement [ 24 ]. In addition, another study by Lerolle et al suggested that in immunocompromised patients, HIV was considered a predisposing condition for hemophagocytic syndrome and was not the actual trigger for HLH [ 25 ].…”