Hyperferritinemic syndrome: Still’s disease and catastrophic antiphospholipid syndrome triggered by fulminant Chikungunya infection: a case report of two patients

Betancur, Juan-Felipe; Navarro, Erika-Paola; Echeverry, Alex; Moncada, Pablo Andrés; Cañas, Carlos A.; Tobón, Gabriel J.

doi:10.1007/s10067-015-3040-9

Cited by 28 publications

(15 citation statements)

References 9 publications

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“…The source of IL-18 in dengue probably involves the interaction of dengue virus with circulating monocytes, since increased production of this cytokine was found in human monocyte cultures infected by DENV-2. The increased production of ferritin has been associated to severe manifestations of some diseases [1,11,14]. This common entity is termed "the hyperferritinemic syndrome."…”

Section: Discussionmentioning

confidence: 99%

Increased serum ferritin and interleukin-18 levels in children with dengue

et al. 2019

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Activated monocytes/macrophages that produce a cytokine storm play an important role in the pathogenesis of dengue. Interleukin-18 (IL-18) is a proinflammatory cytokine produced by monocyte/macrophages that is increased during dengue. Ferritin is an acute-phase reactant and expressed by cells of the reticulo-endothelial system in response to infection by dengue virus. The aims of this study were to analyze the simultaneous expression of both IL-18 and ferritins in children infected by diverse serotypes of dengue virus (DENV) and determine their association with dengue severity. In this regard, children with dengue (n = 25) and healthy controls with similar age and sex (n = 20) were analyzed for circulating ferritin and cytokines. Monocytes were isolated by Hystopaque gradient and co-cultured with DENV-2. IL-18 and ferritin contents in blood, and IL-18 in culture supernatants were determined by ELISA. Increased levels of ferritin and IL-18 (p < 0.0001) were observed in dengue patients, not associated to NS1expression or type of infection (primary or secondary). Highest values of both molecules (p < 0.001) were observed in dengue with warning signs and severe dengue. Differential effect on IL-18/ferritin production was observed associated to viral serotype infection. There were no correlations between ferritin vs. IL-18 production, ferritin vs. NS1 status, and IL-18 vs. NS1 status. Viral-infected monocyte cultures showed increased production of IL-18 (p < 0.001). In conclusion, increased circulating ferritin and IL-18 are expressed in children infected by different serotypes of DENV associated with dengue severity.

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Section: Discussionmentioning

confidence: 99%

Increased serum ferritin and interleukin-18 levels in children with dengue

et al. 2019

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“…However, there are limited data on its clinical use for differentiating among infectious diseases [17, 18]. For infectious diseases, highly elevated serum ferritin has been reported only in several hemorrhagic viral infections, including Dengue [19] and Chikungunya [15] fevers, and viral hepatitis causing liver injury [20]. Although the serum ferritin is elevated as an acute phase reactant in acute extracellular bacterial sepsis, the level is usually not high, because extracellular bacteria trigger hypoferritinemia [21].…”

Section: Discussionmentioning

confidence: 99%

Hyperferritinemia as a Diagnostic Marker for Severe Fever with Thrombocytopenia Syndrome

Kim

et al. 2017

Disease Markers

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Severe fever with thrombocytopenia syndrome (SFTS) is an emerging viral disease in East Asia with high mortality. Few studies have examined markers that suggest SFTS in febrile patients. To determine useful biochemical markers for SFTS, patients aged 18 years or older with SFTS or microbiologically confirmed community-onset bacteremia with thrombocytopenia (BT) at presentation between June 2013 and December 2015 were included from two tertiary university hospitals in Republic of Korea retrospectively. Eleven patients with SFTS and 62 patients with bacteremia and thrombocytopenia were identified in the study period. Age and sex did not show significant difference among two groups. Fever was more commonly observed but comorbidities were less common in SFTS than in BT (P < 0.05, each). The areas under the curves of serum ferritin, C-reactive protein, white blood cell count, serum procalcitonin, and fibrinogen were above 0.9, indicating the discriminative power of these biomarkers (1.000, 0.991, 0.963, 0.931, and 0.934, resp., all P < 0.05). The optimal cutoff value of serum ferritin was 3,822 ng/mL in this study. These results suggest that hyperferritinemia is a typical laboratory feature of SFTS, and the serum ferritin level can be used as a marker for clinicians suspecting SFTS.

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“…Therefore, high ferritin levels after HPV infection might be the potential underlying mechanism of these 2 diseases. 12 …”

Section: Discussionmentioning

confidence: 99%

Refractory Genital HPV Infection and Adult-Onset Still Disease

Zheng²

2016

Medicine

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Adult-onset Still disease (AOSD) is a systemic autoimmune disease (AIID) that can develop after exposure to infectious agents. Genital human papillomavirus (HPV) infection has been reported to induce or exacerbate AIIDs, such as systemic lupus erythematosus (SLE). No guidelines are available for the management of genital warts in AOSD.Case report and literature review.We report a patient who was diagnosed AOSD in the setting of refractory and recurrent genital HPV infection, demonstrating a possible link between HPV infection and AOSD. In addition, we also discuss the management of genital warts in patients with AOSD.To the best of our knowledge, no previous cases of AOSD with genital HPV infection have been reported in literature. We then conclude that the patient AOSD may be triggered by primary HPV infection. Larger number of patient samples is needed to confirm whether HPV could trigger AOSD.

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Hyperferritinemic syndrome: Still’s disease and catastrophic antiphospholipid syndrome triggered by fulminant Chikungunya infection: a case report of two patients

Cited by 28 publications

References 9 publications

Increased serum ferritin and interleukin-18 levels in children with dengue

Increased serum ferritin and interleukin-18 levels in children with dengue

Hyperferritinemia as a Diagnostic Marker for Severe Fever with Thrombocytopenia Syndrome

Refractory Genital HPV Infection and Adult-Onset Still Disease

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