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Han CQ, Xie XR, Zhang Q, Ding Z, Hou XH. Hemophagocytic syndrome as a complication of acute pancreatitis: A case report. World J Clin Cases 2020; 8:2364-2373. [PMID: 32548169 PMCID: PMC7281054 DOI: 10.12998/wjcc.v8.i11.2364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/15/2020] [Accepted: 05/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Haemophagocytic syndrome (HPS) is rarely seen in patients with acute pancreatitis (AP). HPS as a complication of AP in patients without any previous history has not been elucidated.
CASE SUMMARY A 46-year-old man was admitted for symptom of persistent abdominal pain, nausea, and vomiting for 2 d after heavy drinking. During hospital stay, he suddenly developed skin rash and a secondary fever. The laboratory findings revealed progressive pancytopenia, abnormal hepatic tests, and elevation of serum triglyceride, ferritin, and lactate dehydrogenase levels. However, apparent bacterial or viral infections were not detected. He was also possibly related to autoimmune diseases because of positive expression of various autoimmune antibodies and no remarkable past history. Finally, the bone marrow examination showed a histiocytic reactive growth and prominent hemophagocytosis, which resulted in a diagnosis of HPS. Unexpectedly, the patient responded well to the immunosuppressive therapy.
CONCLUSION HPS is a very rare extrapancreatic manifestation of AP. The diagnosis relies on bone marrow examination and immunosuppressive therapy is effective. For AP with skin changes, the possibility of HPS should be considered during clinical work.
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Affiliation(s)
- Chao-Qun Han
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xin-Ru Xie
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Qin Zhang
- Division of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zhen Ding
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xiao-Hua Hou
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Gavand PE, Serio I, Arnaud L, Costedoat-Chalumeau N, Carvelli J, Dossier A, Hinschberger O, Mouthon L, Le Guern V, Korganow AS, Poindron V, Gourguechon C, Lavigne C, Maurier F, Labro G, Heymonet M, Artifoni M, Viau AB, Deligny C, Sene T, Terriou L, Sibilia J, Mathian A, Bloch-Queyrat C, Larroche C, Amoura Z, Martin T. Clinical spectrum and therapeutic management of systemic lupus erythematosus-associated macrophage activation syndrome: A study of 103 episodes in 89 adult patients. Autoimmun Rev 2017; 16:743-749. [PMID: 28483541 DOI: 10.1016/j.autrev.2017.05.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 04/16/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Macrophage activation syndrome (MAS) is a life-threatening hyperinflammatory syndrome that can occur during systemic lupus erythematosus (SLE). Data on MAS in adult SLE patients are very limited. The aim of this study is to describe the clinical characteristics, laboratory findings, treatments, and outcomes of a large series of SLE-associated MAS. METHODS We conducted a retrospective study that included 103 episodes of MAS in 89 adult patients with SLE. RESULTS 103 episodes in 89 adult patients were analyzed. Median age at first MAS episode was 32 (18-80) years. MAS was inaugural in 41 patients (46%).Thirteen patients relapsed. Patients had the following features: fever (100% episodes), increased serum levels of AST (94.7%), LDH (92.3%), CRP (84.5%), ferritin (96%), procalcitonin (41/49 cases). Complications included myocarditis (n=22), acute lung injury (n=15) and seizures (n=11). In 33 episodes, patients required hospitalization in an ICU and 5 died. Thrombocytopenia and high CRP levels were associated independently with an increased risk for ICU admission. High dose steroids alone as first line therapy induced remission in 37/57 cases (65%). Additional medications as first or second line therapies included IV immunoglobulins (n=22), cyclophosphamide (n=23), etoposide (n=11), rituximab (n=3). Etoposide and cyclophosphamide-based regimens had the best efficacy. CONCLUSION MAS is a severe complication and is often inaugural. High fever and high levels of AST, LDH, CRP, ferritin and PCT should be considered as red flags for early diagnosis. High dose steroids lead to remission in two third of cases. Cyclophosphamide or etoposide should be considered for uncontrolled/severe forms.
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Affiliation(s)
| | - Ilaria Serio
- Division of Internal Medicine, Department of Medical & Surgical Sciences, University of Bologna, S Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Nathalie Costedoat-Chalumeau
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, Hôpital Cochin, France
| | - Julien Carvelli
- Service de médecine interne et d'immunologie clinique, CHU Conception Marseille - APHM, France
| | - Antoine Dossier
- Service de médecine interne CHU Bichat, Paris, Université paris VII, France
| | | | - Luc Mouthon
- Service de médecine interne, hôpital Cochin, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, DHU Authors (Autoimmune and Hormonal Diseases), Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Véronique Le Guern
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, Hôpital Cochin, France
| | | | - Vincent Poindron
- Service d'immunologie Clinique et médecine interne, CHU de Strasbourg, France
| | | | | | - François Maurier
- Service de médecine Interne et Immunologie Clinique, HP Metz Site Belle Isle, France
| | | | - Marie Heymonet
- CHU de Nancy, Internal Medicine and Clinical immunology Department, France
| | | | | | | | - Thomas Sene
- Service de médecine Interne, Groupe Hospitalier Diaconesses, Croix Saint-Simon, Paris, France
| | - Louis Terriou
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000 Lille, France
| | | | - Alexis Mathian
- Service de médecine interne 2, Groupement hospitalier La Pitié-Salpétrière, Paris, France
| | | | | | - Zahir Amoura
- Service de médecine interne 2, Groupement hospitalier La Pitié-Salpétrière, Paris, France
| | - Thierry Martin
- Service d'immunologie Clinique et médecine interne, CHU de Strasbourg, France
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