Typhoid Fever Complicated by Hemophagocytic Lymphohistiocytosis and Rhabdomyolysis

Non, Lemuel; Patel, Rupa; Esmaeeli, A; Despotović, Vladimir

doi:10.4269/ajtmh.15-0385

Cited by 27 publications

(14 citation statements)

References 14 publications

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“…He also did not have any clinical evidence of intestinal perforation and his renal function remained normal throughout his admission. Considering our patient’s pancytopenia, we considered the possibility of infection-associated hemophagocytic syndrome as a complication of his typhoid fever, because this has been previously reported [10]. Given that he was slowly improving clinically, we decided to observe him closely without performing additional invasive tests, such as bone marrow examination.…”

Section: Discussionmentioning

confidence: 99%

Severe thrombocytopenia in a child with typhoid fever: a case report

2016

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BackgroundAlthough thrombocytopenia is common in typhoid fever, its course, response to treatment, and need for specific therapies such as platelet transfusion are not well characterized.Case presentationWe report a case of typhoid fever in a 4-year-old Asian male returned traveler, admitted with prolonged fever and found to have severe thrombocytopenia (platelets 16 × 109/L). Despite appropriate antibiotic therapy, his platelet recovery was slow, but did not lead to complications and he did not require platelet transfusion.ConclusionsThere is no consensus in the medical literature guiding the optimal management of severe thrombocytopenia in typhoid fever, but it may improve with conservative management, as in our case. The epidemiology and management of this condition merits further research to guide clinical practice.

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Section: Discussionmentioning

confidence: 99%

Severe thrombocytopenia in a child with typhoid fever: a case report

2016

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“…Our patient responded to antibiotics and supportive treatment alone. Previous reports have also documented success with this approach [ 8 - 10 ].…”

Section: Discussionmentioning

confidence: 96%

Infection-associated Hemophagocytic Lymphohistiocytosis: An Unusual Clinical Masquerader

Abbas

Raza

Majid

et al. 2018

Cureus

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Hemophagocytic lymphohistiocytosis (HLH) secondary to an infection is a great impersonator. It is caused by hyperimmune activation, which leads to a wide array of hematological abnormalities. If the disease is untreated, it is usually fatal. We report the case of a four-year-old girl who presented to our tertiary care hospital with high-grade fever, frequent loose stools, and bleeding from the lips and gums. Investigations showed pancytopenia, hyperferritinemia, hypofibrinogenemia, and hypertriglyceridemia whereas the bone marrow biopsy revealed hemophagocytosis with trilineage suppression. Blood cultures grew Salmonella typhi. After ruling out other possibilities, the diagnosis of HLH was made as per the HLH-2004 diagnostic criteria. The patient responded well to culture-sensitive antibiotics and supportive treatment. We discuss the diagnosis and clinical course of this unique case and strive to create awareness about secondary HLH induced by common diseases, such as typhoid fever.

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“…Several cases of adult-onset sHLH associated with severe Gram-negative bacterial infection such as Salmonella typhi, Escherichia coli, Klebsiella pneumoniae and Haemophils parainfluenzae have been reported. 46-49 Thus, SAMP1/TA-1 mice are a useful model to investigate the pathogenesis of bacterial infection-associated sHLH.…”

Section: Discussionmentioning

confidence: 99%

Senescence-accelerated mice (SAMP1/TA-1) treated repeatedly with lipopolysaccharide develop a condition that resembles hemophagocytic lymphohistiocytosis

et al. 2019

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Hemophagocytic lymphohistiocytosis is a life-threatening systemic hyperinflammatory disorder with primary and secondary forms. Primary hemophagocytic lymphohistiocytosis is associated with inherited defects in various genes that affect the immunological cytolytic pathway. Secondary hemophagocytic lymphohistiocytosis is not inherited, but complicates various medical conditions including infections, autoinflammatory/autoimmune diseases, and malignancies. When senescence-accelerated mice (SAMP1/TA-1) with latent deterioration of immunological function and senescence-resistant control mice (SAMR1) were treated repeatedly with lipopolysaccharide, SAMP1/TA-1 mice displayed the clinicopathological features of hemophagocytic lymphohistiocytosis such as hepatosplenomegaly, pancytopenia, hypofibrinogenemia, hyperferritinemia, and hemophagocytosis. SAMR1 mice showed no features of hemophagocytic lymphohistiocytosis. Lipopolysaccharide induced upregulation of proinflammatory cytokines such as interleukin-1β, interleukin-6, tumor necrosis factor-α, and interferon-γ, and interferon-γ-inducible chemokines such as c-x-c motif chemokine ligands 9 and 10 in the liver and spleen in both SAMP1/TA-1 and SAMR1 mice. However, upregulation of proinflammatory cytokines and interferon-γ-inducible chemokines in the liver persisted for longer in SAMP1/TA-1 mice than in SAMR1 mice. In addition, the magnitude of upregulation of interferon-γ in the liver and spleen after lipopolysaccharide treatment was greater in SAMP1/TA-1 mice than in SAMR1 mice. Furthermore, lipopolysaccharide treatment led to a prolonged increase in the proportion of peritoneal M1 macrophages and simultaneously to a decrease in the proportion of M2 macrophages in SAMP1/TA-1 mice compared with SAMR1 mice. Lipopolysaccharide appeared to induce a hyperinflammatory reaction and prolonged inflammation in SAMP1/TA-1 mice, resulting in features of secondary hemophagocytic lymphohistiocytosis. Thus, SAMP1/TA-1 mice represent a useful mouse model to investigate the pathogenesis of bacterial infection-associated secondary hemophagocytic lymphohistiocytosis.

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Typhoid Fever Complicated by Hemophagocytic Lymphohistiocytosis and Rhabdomyolysis

Cited by 27 publications

References 14 publications

Severe thrombocytopenia in a child with typhoid fever: a case report

Severe thrombocytopenia in a child with typhoid fever: a case report

Infection-associated Hemophagocytic Lymphohistiocytosis: An Unusual Clinical Masquerader

Senescence-accelerated mice (SAMP1/TA-1) treated repeatedly with lipopolysaccharide develop a condition that resembles hemophagocytic lymphohistiocytosis

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