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Zimilover A, Huml I. Haemophagocytic lymphohistiocytosis (HLH) in an adult following treatment with trimethoprim/sulfamethoxazole. BMJ Case Rep 2022; 15:15/12/e251255. [PMID: 36517076 PMCID: PMC9756175 DOI: 10.1136/bcr-2022-251255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Haemophagocytic lymphohistiocytosis (HLH) is an aggressive hyperinflammatory haematological condition often associated with malignancy, infection or rheumatological disorders. HLH has rarely been associated with medications, including antibiotics. We describe a case of a patient without significant medical history who presented with HLH following treatment with trimethoprim/sulfamethoxazole (TMP/SMX). Additionally, we will discuss the possible mechanism of medication-induced HLH as well as the successful use of dexamethasone as the sole treatment. Early diagnosis and treatment of this disease is critical and medication-induced HLH should be considered in cases without a clear aetiology. To our knowledge, this is the first case report of TMP/SMX-induced HLH that was successfully treated with steroid monotherapy and just the second case report of TMP/SMX-induced HLH.
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Affiliation(s)
- Adam Zimilover
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Isaac Huml
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
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2
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Demarez B, Eté M, David L, Quiles N, Archier E. Macrophage activation syndrome associated with BRAF and MEK inhibitors during adjuvant treatment of melanoma. J Eur Acad Dermatol Venereol 2022; 36:e688-e689. [DOI: 10.1111/jdv.18130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/22/2022] [Accepted: 03/25/2022] [Indexed: 11/28/2022]
Affiliation(s)
- B Demarez
- Dermatologie Hopital Saint Joseph France
| | - M Eté
- Medecine interne Hopital Saint Joseph France
| | - L David
- Dermatologie Hopital Saint Joseph France
| | - N Quiles
- Dermatologie Hopital Saint Joseph France
| | - E Archier
- Dermatologie Hopital Saint Joseph France
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3
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Saper VE, Chen G, Khatri P, Mellins ED. Response to: ‘Effectiveness and safety of ruxolitinib for the treatment of refractory systemic idiopathic juvenile arthritis like associated with interstitial lung disease: case report’ by Bader-Meunier et al. Ann Rheum Dis 2022; 81:e21. [DOI: 10.1136/annrheumdis-2020-217000] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 11/04/2022]
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4
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Carter Febres M, Abbott J, Cipriano SD, Knackstedt ED, George TI, Afify Z. Drug reaction with eosinophilia and systemic symptoms (DRESS)-associated hemophagocytic lymphohistiocytosis (HLH), an important and underrecognized HLH mimic: A case report. Pediatr Blood Cancer 2021; 68:e28657. [PMID: 32808435 DOI: 10.1002/pbc.28657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Maria Carter Febres
- Department of Pediatric Hematology Oncology, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - James Abbott
- Department of Dermatology, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - Sarah D Cipriano
- Department of Dermatology, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - Elizabeth Doby Knackstedt
- Department of Pediatric Infectious Disease, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - Tracy I George
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Zeinab Afify
- Department of Pediatric Hematology Oncology, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
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5
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Yang JJ, Lei DK, Ravi V, Maloney NJ, Crew A, Worswick S. Overlap between hemophagocytic lymphohistiocytosis and drug reaction and eosinophilia with systemic symptoms: a review. Int J Dermatol 2020; 60:925-932. [PMID: 32964443 DOI: 10.1111/ijd.15196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/21/2020] [Accepted: 08/26/2020] [Indexed: 12/17/2022]
Abstract
Drug reaction and eosinophilia with systemic symptoms (DRESS), also known as drug-induced hypersensitivity syndrome (DIHS), shares features with hemophagocytic lymphohistiocytosis (HLH), most notably fever, rash, and internal organ involvement. However, there is increasing recognition of drug-induced (secondary) HLH and biopsy-proven hemophagocytosis in DRESS, suggesting that HLH and DRESS not only overlap but also may be diseases on the same spectrum of immune dysfunction. To characterize existing literature on HLH/DRESS overlap, we queried the PubMed/MEDLINE database for 23 cases of HLH-DRESS codiagnosis. Average time-to-onset of rash after exposure to inciting drug was 2.7 weeks. Fourteen cases (61%) clinically worsened despite initial therapy, prompting a workup with diagnosis of HLH on average 2.3 weeks after diagnosing DRESS. Nine cases met HLH diagnostic criteria and had a RegiSCAR score ≥4. Nine cases met one set of criteria with a presentation suggestive of the other. Five cases met neither criteria. A patient presenting with fever, generalized rash, bicytopenia, and internal organ involvement after drug exposure was most predictive of meeting diagnostic criteria for both HLH and DRESS. Treatment was highly variable, although most initiated systemic corticosteroids with/without IVIG, plasmapheresis, or etoposide. Patients with poor outcomes in this review were treated using steroid monotherapy and had viral reactivation. Dermatologists should consider the possibility of HLH in any patient presenting with fever, rash, internal organ involvement, and cytopenia. Additional studies will be necessary to further characterize HLH and DRESS overlap and determine optimal management.
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Affiliation(s)
- Jason J Yang
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Donald K Lei
- Department of Dermatology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Vignesh Ravi
- Department of Dermatology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Nolan J Maloney
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ashley Crew
- Department of Dermatology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Scott Worswick
- Department of Dermatology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
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6
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Saper VE, Chen G, Guillerman RP, Khatri P, Cron RQ, Mellins ED. Response to: 'Successful treatment of plasma exchange for refractory systemic juvenile idiopathic arthritis complicated with macrophage activation syndrome and severe lung disease' by Sato et al. Ann Rheum Dis 2020; 81:e62. [PMID: 32317313 DOI: 10.1136/annrheumdis-2020-217426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Vivian E Saper
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Guangbo Chen
- Institute for Immunity, Transplantation and Infection, Center for Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, California, USA
| | - R Paul Guillerman
- Department of Pediatric Radiology, Texas Children's Hospital, Houston, Texas, USA
| | - Purvesh Khatri
- Institute for Immunity, Transplantation and Infection, Center for Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, California, USA
| | - Randy Q Cron
- Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth D Mellins
- Department of Pediatrics, Program in Immunology, Stanford University, Stanford, CA, USA
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7
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Adult-Onset Still’s Disease. PERIODIC AND NON-PERIODIC FEVERS 2020. [PMCID: PMC7123329 DOI: 10.1007/978-3-030-19055-2_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adult-onset Still’s disease (AoSD) is a rare but clinically well-known, polygenic, systemic autoinflammatory disease. It is typically characterized by four main (cardinal) symptoms: spiking fever ≥39 °C, arthralgia or arthritis, skin rash, and hyperleukocytosis (≥10,000 cells/mm3). However, many other clinical features are possible, and it can appear in all age groups with potentially severe inflammatory onset accompanied by a broad spectrum of disease manifestation and complications. Hence, it remains a diagnostic challenge, and the clinician should first rule out infectious, tumoral, or inflammatory differential diagnoses. Determination of the total and glycosylated ferritin levels, although not pathognomonic, can help in diagnosis. New biomarkers have recently been described, but they need to be validated. The disease evolution of AoSD can be monocyclic, polycyclic, or chronic. In chronic disease, a joint involvement is often predominant, and erosions are noted in one-third of patients. Many progresses have been made in the understanding of the pathogenesis over the last decades. This chapter provides a comprehensive insight into the complex and heterogeneous nature of AoSD describing the identified cytokine signaling pathways and biomarkers. It also discusses the current evidence for the usage of biologics in AoSD to provide guidance for treatment decisions, taking into account both the efficacy and the safety of the different therapeutic options.
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8
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Zhou JY, Martinez JA, Shen JP. Lamotrigine-induced hemophagocytic lymphohistiocytosis with Takotsubo cardiomyopathy: a case report. J Med Case Rep 2019; 13:345. [PMID: 31767022 PMCID: PMC6878683 DOI: 10.1186/s13256-019-2295-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/16/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hemophagocytic lymphohistiocytosis is a rare hematological syndrome characterized by excessive and uncontrolled activation of the immune system. The often nonspecific nature of early symptoms and the potential for progression to multiorgan failure and death if appropriate therapy is not started promptly, highlight the importance of heightened recognition for this uncommon disease. Although there are well-described associations of hemophagocytic lymphohistiocytosis with infectious, malignant, and autoimmune diseases and an established treatment protocol for these cases, the link between medications and hemophagocytic lymphohistiocytosis is less clearly established and the optimal treatment of these cases less well defined. CASE PRESENTATION Here we describe the case of a 45-year-old caucasian woman presenting with signs and symptoms consistent with hemophagocytic lymphohistiocytosis, induced by recent exposure to lamotrigine. She had a rapidly progressive clinical course, complicated by multiorgan failure including stress-induced Takotsubo cardiomyopathy and cardiac arrest. With dexamethasone and etoposide therapy, she made a full and sustained recovery. CONCLUSIONS This case highlights that medication-induced hemophagocytic lymphohistiocytosis appears to respond similarly to the same dexamethasone and etoposide treatment regimen developed for other non-drug-induced forms of hemophagocytic lymphohistiocytosis. With the continued cessation of the offending agent there has not been need for maintenance therapy and no relapse to date. In addition, given the risk for cardiomyopathy, a clinical complication not classically associated with hemophagocytic lymphohistiocytosis, echocardiogram and telemetry monitoring should be considered in the initial workup of suspected hemophagocytic lymphohistiocytosis.
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Affiliation(s)
- Jenny Y Zhou
- Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Jordan A Martinez
- Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - John Paul Shen
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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9
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Feist E, Mitrovic S, Fautrel B. Mechanisms, biomarkers and targets for adult-onset Still's disease. Nat Rev Rheumatol 2019; 14:603-618. [PMID: 30218025 PMCID: PMC7097309 DOI: 10.1038/s41584-018-0081-x] [Citation(s) in RCA: 231] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Adult-onset Still’s disease (AoSD) is a rare but clinically well-known, polygenic, systemic autoinflammatory disease. Owing to its sporadic appearance in all adult age groups with potentially severe inflammatory onset accompanied by a broad spectrum of disease manifestation and complications, AoSD is an unsolved challenge for clinicians with limited therapeutic options. This Review provides a comprehensive insight into the complex and heterogeneous nature of AoSD, describing biomarkers of the disease and its progression and the cytokine signalling pathways that contribute to disease. The efficacy and safety of biologic therapeutic options are also discussed, and guidance for treatment decisions is provided. Improving the approach to AoSD in the future will require much closer cooperation between paediatric and adult rheumatologists to establish common diagnostic strategies, treatment targets and goals. Adult-onset Still’s disease (AoSD) is not easily diagnosed, and treatment options are limited. This Review provides an overview of the disease and its pathogenesis, clinical trial results, therapeutic options and a plan to diagnose and clinically manage these patients. Similar to systemic-onset juvenile idiopathic arthritis, adult-onset Still’s disease (AoSD) is a rare systemic autoinflammatory disease with potentially severe inflammatory onset accompanied by a broad spectrum of disease manifestation and complications. AoSD should be considered in patients with persistent fever, and the diagnosis is based on the combination of clinical and laboratory findings as well as the exclusion of other inflammatory conditions. Central to the pathogenesis of AoSD is the intense activation of innate immune cells and overproduction of several pro-inflammatory cytokines including IL-1, IL-6 and IL-18. Two IL-1 antagonists have been approved for treatment of AoSD, and growing evidence suggests that other biologic agents are therapeutic options, such as anti-IL-6 and anti-IL-18 therapeutics. As a reliable prediction of response and outcome is not possible, therapeutic decisions have to be made on the basis of clinical, biological or imaging characteristics of disease. A close cooperation between paediatric and adult rheumatologists is required to establish common diagnostic strategies, treatment targets and goals.
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Affiliation(s)
- Eugen Feist
- Department of Rheumatology and Clinical Immunology, Charité- Universitätsmedizin, Berlin, Germany.
| | - Stéphane Mitrovic
- Department of Rheumatology, AP-HP, Pitié-Salpêtrière Hospital, AP-HP, Paris, France. .,Department of Internal Medicine, Institut Mutualiste Montsouris, Paris, France.
| | - Bruno Fautrel
- Department of Rheumatology, AP-HP, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Sorbonne Université, GRC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
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10
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Griscelli Type 2 Syndrome and Hemophagocytic Lymphohistiocytosis: Sisters With the Same Mutation but Different Presentations. J Pediatr Hematol Oncol 2019; 41:473-477. [PMID: 31233462 DOI: 10.1097/mph.0000000000001522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Griscelli syndrome type 2 (GS2) is an autosomal recessive condition associated with the development of hemophagocytic lymphohistiocytosis. GS2 is caused by a gene mutation involving RAB27A, which affects a melanosome anchoring complex in melanocytes and releases cytolytic granules from T cells and natural killer cells. GS2 is known to have immunologic compromise and oculocutaneous albinism. We present the case of 2 sisters who had vastly different phenotypic presentations despite having the same genetic frameshift mutation in the RAB27A gene. Patient 1 presented with seizures and neurological compromise, whereas patient 2 presented with pancytopenia and diarrhea. Both patients developed hemophagocytic lymphohistiocytosis.
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11
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Noseda R, Bertoli R, Müller L, Ceschi A. Haemophagocytic lymphohistiocytosis in patients treated with immune checkpoint inhibitors: analysis of WHO global database of individual case safety reports. J Immunother Cancer 2019; 7:117. [PMID: 31046841 PMCID: PMC6498487 DOI: 10.1186/s40425-019-0598-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitor (ICI) use in clinical practice has unravelled a spectrum of immune-related adverse events (irAEs) due to immune system hyper-activation. ICI-related haemophagocytic lymphohistiocytosis (HLH) has been recently outlined in single case reports, raising a concern about the need of increasing our knowledge on this rare yet life threatening ICI haematological toxicity. METHODS To determine ICI-related HLH clinical, haematological, and coagulation features, its timing and outcome, concurrent irAEs and concomitant infections, we performed a retrospective observational cross-sectional study and queried VigiBase, the WHO global database of suspected adverse drug reactions (ADRs), on September 30th, 2018. We retrieved the individual case safety reports reporting HLH in association with ipilimumab, nivolumab, pembrolizumab, atezolizumab, avelumab or durvalumab, gathered in the database starting from the ICIs' approval dates by the US Food and Drug Administration. The main outcome measures were co-suspected drugs, concurrent irAEs, HLH clinical, haematological and coagulation features, concomitant infections, HLH median time to onset and outcome. RESULTS Among 49'883 ICI-related ADRs collated in VigiBase as of September 30th, 2018, HLH was reported in 38 cases of which 34 (90%) mentioned ICIs as the solely suspected drugs. ICI-related HLH showed clinical, haematological and coagulation features similar to those of HLH with different etiology. Concurrent irAEs occurred in 5 (13%) patients and 6 (16%) reported concomitant viral infections. 31 (82%) cases defined ICI-related HLH outcome, which resolved in 19 (61%) cases. HLH developed a median of 6.7 weeks after initiation of ICI treatment (IQR 2.9-15.4, n = 18, 47%). CONCLUSIONS By evaluating the largest cohort of ICI-related HLH cases, we observed that ICI-related HLH arises with a delayed timing with respect to initiation of ICI treatment, and usually presents without other irAEs and concomitant infections. Keeping in mind these findings, clinicians should consider ICIs' involvement in the onset of HLH whenever they diagnose a disease of this group of syndromes in cancer patients treated with ICIs.
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Affiliation(s)
- Roberta Noseda
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Via Tesserete 46, 6903, Lugano, Switzerland.
| | - Raffaela Bertoli
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Via Tesserete 46, 6903, Lugano, Switzerland
| | - Laura Müller
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Via Tesserete 46, 6903, Lugano, Switzerland
| | - Alessandro Ceschi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Via Tesserete 46, 6903, Lugano, Switzerland.,Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
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12
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Miyabayashi H, Kumaki S, Sato A, Onuma R, Noguchi R, Sato T, Metoki T, Watanabe Y, Tazawa Y, Imaizumi M, Kitaoka S. Onset of Hemophagocytic Lymphohistiocytosis during Piperacillin-Tazobactam Therapy in Three Children with Acute Focal Bacterial Nephritis. TOHOKU J EXP MED 2018; 245:55-59. [DOI: 10.1620/tjem.245.55] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Atsushi Sato
- Department of Hematology and Oncology, Miyagi Children’s Hospital
| | | | - Rie Noguchi
- Department of Pediatrics, Sendai Medical Center
| | - Taiki Sato
- Department of Pediatrics, Sendai Medical Center
| | | | | | | | - Masue Imaizumi
- Department of Hematology and Oncology, Miyagi Children’s Hospital
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13
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Kernan KF, Carcillo JA. Hyperferritinemia and inflammation. Int Immunol 2017; 29:401-409. [PMID: 28541437 PMCID: PMC5890889 DOI: 10.1093/intimm/dxx031] [Citation(s) in RCA: 328] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/23/2017] [Indexed: 12/18/2022] Open
Abstract
Understanding of ferritin biology has traditionally centered on its role in iron storage and homeostasis, with low ferritin levels indicative of deficiency and high levels indicative of primary or secondary hemochromatosis. However, further work has shown that iron, redox biology and inflammation are inexorably linked. During infection, increased ferritin levels represent an important host defense mechanism that deprives bacterial growth of iron and protects immune cell function. It may also be protective, limiting the production of free radicals and mediating immunomodulation. Additionally, hyperferritinemia is a key acute-phase reactants, used by clinicians as an indication for therapeutic intervention, aimed at controlling inflammation in high-risk patients. One school of thought maintains that hyperferritinemia is an 'innocent bystander' biomarker of uncontrolled inflammation that can be used to gauge effectiveness of intervention. Other schools of thought maintain that ferritin induction could be a protective negative regulatory loop. Others maintain that ferritin is a key mediator of immune dysregulation, especially in extreme hyperferritinemia, via direct immune-suppressive and pro-inflammatory effects. There is a clear need for further investigation of the role of ferritin in uncontrolled inflammatory conditions both as a biomarker and mediator of disease because its occurrence identifies patients with high mortality risk and its resolution predicts their improved survival.
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Affiliation(s)
- Kate F Kernan
- Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261, USA
| | - Joseph A Carcillo
- Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261, USA
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14
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Pièges diagnostiques d’un syndrome d’activation macrophagique. Arch Pediatr 2017; 24:254-259. [DOI: 10.1016/j.arcped.2016.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/26/2016] [Accepted: 12/16/2016] [Indexed: 12/17/2022]
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15
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Tey KR, Barrett K, Jain R, Boyer TD, Desai A. Vanishing Bile Duct Syndrome with Hemophagocytic Lymphohistiocytosis After Minimal Change Disease. Am J Med 2016; 129:e315-e319. [PMID: 27316571 DOI: 10.1016/j.amjmed.2016.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 11/17/2022]
MESH Headings
- Acute Disease
- Adult
- Bile Duct Diseases/complications
- Bile Duct Diseases/diagnostic imaging
- Bile Duct Diseases/drug therapy
- Bile Duct Diseases/pathology
- Biopsy, Needle
- Disease Progression
- Drug Therapy, Combination
- Fatal Outcome
- Female
- Humans
- Immunohistochemistry
- Liver Function Tests
- Lymphohistiocytosis, Hemophagocytic/complications
- Lymphohistiocytosis, Hemophagocytic/diagnostic imaging
- Lymphohistiocytosis, Hemophagocytic/drug therapy
- Lymphohistiocytosis, Hemophagocytic/pathology
- Magnetic Resonance Imaging/methods
- Nephrosis, Lipoid/complications
- Nephrosis, Lipoid/diagnostic imaging
- Nephrosis, Lipoid/drug therapy
- Nephrosis, Lipoid/pathology
- Rare Diseases
- Risk Assessment
- Severity of Illness Index
- Syndrome
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Affiliation(s)
- Kai Rou Tey
- Department of Internal Medicine, University of Arizona College of Medicine South Campus, Tucson.
| | - Kristen Barrett
- Department of Gastroenterology, University of Arizona College of Medicine, Tucson
| | - Richa Jain
- Department of Pathology, University of Arizona College of Medicine, Tucson
| | - Thomas D Boyer
- Department of Gastroenterology, University of Arizona College of Medicine, Tucson
| | - Archita Desai
- Department of Gastroenterology, University of Arizona College of Medicine, Tucson
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16
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Lakhoua G, Aouinti I, Sahnoun R, Kastalli S, Daghfous R, Zaïem A. A hemophagocytosis syndrome attributed to phenobarbital. Presse Med 2016; 45:379-81. [DOI: 10.1016/j.lpm.2015.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/06/2015] [Accepted: 12/08/2015] [Indexed: 01/16/2023] Open
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17
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Gauchan D, Shaaban H, Parikh N, Chang NL, Altheeb Z, Maroules M. Severe hemophagocytic lymphohistiocytosis as a complication of drug-induced hypersensitivity syndrome. Int J Crit Illn Inj Sci 2015; 5:60-1. [PMID: 25810969 PMCID: PMC4366833 DOI: 10.4103/2229-5151.152349] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Dron Gauchan
- Department of Hematology and Oncology, St Joseph's Regional Medical Center, Paterson, New Jersey, USA
| | - Hamid Shaaban
- Department of Hematology and Oncology, St Joseph's Regional Medical Center, Paterson, New Jersey, USA
| | - Neil Parikh
- Department of Medicine, St Joseph's Regional Medical Center, Paterson, New Jersey, USA
| | - Nai-Lun Chang
- Department of Pathology, St Joseph's Regional Medical Center, Paterson, New Jersey, USA
| | - Zaid Altheeb
- Department of Medicine, St Joseph's Regional Medical Center, Paterson, New Jersey, USA
| | - Michael Maroules
- Department of Hematology and Oncology, St Joseph's Regional Medical Center, Paterson, New Jersey, USA
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18
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Ahluwalia J, Arkin L, Boos M, Dunn M, Treat J. Peripheral bands in the setting of drug hypersensitivity syndrome. J Am Acad Dermatol 2014; 71:e153-4. [PMID: 25219744 DOI: 10.1016/j.jaad.2014.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 06/03/2014] [Accepted: 06/03/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Jusleen Ahluwalia
- Robert Wood Johnson Medical School, New Brunswick, New Jersey; Section of Dermatology, Children's Hospital of Philadelphia, Pennsylvania.
| | - Lisa Arkin
- Section of Dermatology, Children's Hospital of Philadelphia, Pennsylvania
| | - Markus Boos
- Section of Dermatology, Children's Hospital of Philadelphia, Pennsylvania; Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Michelle Dunn
- Department of Pediatrics, Children's Hospital of Philadelphia, Pennsylvania
| | - James Treat
- Section of Dermatology, Children's Hospital of Philadelphia, Pennsylvania
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Vernier M, Million M, Laugier D, Le Treut T, Brouqui P, Botelho-Nevers E. Macrophage activation syndrome associated with co-trimoxazole. Med Mal Infect 2013; 43:128-30. [PMID: 23537744 DOI: 10.1016/j.medmal.2013.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 02/20/2013] [Accepted: 02/20/2013] [Indexed: 11/18/2022]
Affiliation(s)
- M Vernier
- Faculté de Médecine, Université Aix-Marseille, Institut Hospitalo-Universitaire Méditerranée Infection, 27 Boulevard Jean-Moulin, 13385 Marseille Cedex 5, France
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Michot JM, Hié M, Galicier L, Lambotte O, Michel M, Bloch-Queyrat C, Hermine O. Le syndrome d’activation lymphohistiocytaire de l’adulte. Rev Med Interne 2013; 34:85-93. [DOI: 10.1016/j.revmed.2012.07.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 05/08/2012] [Accepted: 07/30/2012] [Indexed: 11/30/2022]
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Li H, Li X, Liao XX, Zhan H, Xiong Y, Hu CL, Wei HY, Jing XL. Drug associated vanishing bile duct syndrome combined with hemophagocytic lymphohistiocytosis. World J Gastrointest Endosc 2012; 4:376-8. [PMID: 22912913 PMCID: PMC3423520 DOI: 10.4253/wjge.v4.i8.376] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 03/02/2012] [Accepted: 08/08/2012] [Indexed: 02/05/2023] Open
Abstract
A 28-year-old woman with untreated autoimmune disorder, demonstrated skin rash and fever after taking Amoxicillin-clavulanate and developed progressive jaundice. A bone marrow aspiration indicated an increased number of macrophages with hemophagocytosis and liver biopsy showed pure centrilobular cholestasis with necrosis and some absence of portal bile ducts. Furthermore, a serological test for Epstein-Barr virus was positive. Under treatment by liver dialysis and administration of steroids led to rapidly defervescence and clinical improvement. However, liver enzymes were still markedly elevated with persistent anemia, even after immunosuppressive treatment. The patient is currently waiting for liver transplantation. This is the first description of vanishing bile duct syndrome combined with hemophagocytic lymphohistiocytosis, with underlying causes including infection, drug-induced factors and untreated autoimmune disorder.
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Affiliation(s)
- Hui Li
- Hui Li, Xin Li, Xiao-Xing Liao, Hong Zhan, Yan Xiong, Chun-Lin Hu, Hong-Yan Wei, Xiao-Li Jing, Department of Emergency, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
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Ben M'rad M, Leclerc-Mercier S, Blanche P, Franck N, Rozenberg F, Fulla Y, Guesmi M, Rollot F, Dehoux M, Guillevin L, Moachon L. Drug-induced hypersensitivity syndrome: clinical and biologic disease patterns in 24 patients. Medicine (Baltimore) 2009; 88:131-140. [PMID: 19440116 DOI: 10.1097/md.0b013e3181a4d1a1] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Drug-induced hypersensitivity syndrome (DIHS), also called drug rash with eosinophilia and systemic symptoms (DRESS), is a severe reaction usually characterized by fever, rash, and multiorgan failure, occurring 1-8 weeks after drug introduction. It is an immune-mediated reaction involving macrophage and T-lymphocyte activation and cytokine release, although no consensus has been reached as to its etiology. The skin, hematopoietic system, and liver are frequently involved. DIHS can mimic severe sepsis, viral infection, adult-onset Still disease (AOSD), or lymphoproliferation.We describe 24 consecutive patients with DIHS who were hospitalized between September 2004 and March 2008. Criteria for inclusion in this observational study were suspected drug reaction, eosinophilia >or=500/microL and/or atypical lymphocytes, involvement of at least 2 organs (skin being 1 of them), with suggestive chronology and exclusion of other diagnoses. Our cohort of 12 women and 12 men had a median age of 49 years (range, 22-82 yr), and 11 had skin phototype V or VI. Patients with mild or no rash were immunocompromised (7/24)- defined as treatment with prednisone (>or=10 mg/d) and another immunosuppressant drug, or human immunodeficiency virus infection. All patients were febrile (>38 degrees C), 14 had localized or generalized edema, 7 had pharyngitis, 8 had lymphadenopathy, 22 had hepatitis, 4 had nephritis, 2 had noninfectious and nonlithiasic angiocholitis or cholecystitis. Ten patients were hypotensive, 5 of whom had associated laboratory signs and/or imaging findings suggestive of acute myocardial dysfunction. Half of the patients had hemogram abnormalities, including eosinophilia. Nine DIHS patients fulfilled the Fautrel criteria for AOSD diagnosis, including glycosylated ferritin <20% in 4/11, with or without laboratory characteristics of hemophagocytosis. Twenty DIHS episodes occurred during the less sunny months of October to March.We determined 25-hydroxyvitamin D3 (25[OH]D3) levels in 18 patients and found that 9 patients had vitamin D deficiency (<25 nmol/L or <10 microg/L) and 5 had vitamin D insufficiency (25-50 nmol/L). Moreover, 25(OH)D3 levels were inversely correlated with ferritin values. After culprit-drug withdrawal, outcomes were favorable for all patients, including those with cardiac abnormalities under slow tapering of glucocorticoids.We recommend looking for the frequent but underdiagnosed hypersensitivity myocarditis with noninvasive diagnostic tools, such as N-terminal probrain natriuretic peptide, and promptly withdrawing the culprit drug and starting glucocorticoids. Vitamin D deficiency might be a DIHS risk or severity factor, especially for patients with high skin phototype and during the winter. Because DIHS clinical and laboratory patterns share similarities with AOSD and hemophagocytosis, DIHS should be included in their differential diagnoses.
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Affiliation(s)
- Mona Ben M'rad
- From the Department of Internal Medicine, Reference Center for Autoimmune and Inflammatory Diseases: Necrotizing Vasculitides and Systemic Sclerosis (MB, PB, F Rollot, LG), Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Descartes University (MB, SL, F Rozenberg, YF, MG, LG, LM), Paris; Department of Dermatology (SL, NF), Department of Virology (F Rozenberg), Department of Biophysics (YF), and Department of Radiology (MG), Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris; Department of Biochemistry (MD), Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris; and Regional Pharmacovigilance Center and Department of Pharmacology (LM), Assistance Publique-Hôpitaux de Paris, Paris, France
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A case of tuberculosis-induced hemophagocytic lymphohistiocytosis in a patient under hemodialysis. Int J Hematol 2009; 89:298-301. [DOI: 10.1007/s12185-009-0265-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 01/22/2009] [Indexed: 10/21/2022]
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Abstract
Adult-onset Still disease (AOSD) is an uncommon inflammatory condition of unknown origin typically characterized by four main (cardinal) symptoms: spiking fever > or =39 degrees C, arthralgia or arthritis, skin rash and hyperleucocytosis (> or =10,000 cells/mm3) with neutrophils > or =80%. As many other manifestations are possible, diagnosis is potentially challenging. Determination of the total and glycosylated ferritin levels, although not pathognomonic, can help in diagnosis. The disease evolution of AOSD can be monocyclic, polycyclic or chronic. In chronic disease, joint involvement is often predominant and erosions are noted in one-third of patients. No prognostic factors have been identified to date. Therapeutic strategies are from observational data. Corticosteroids are usually the first-line treatment. With inadequate response to corticosteroids, methotrexate appears the best choice to control disease activity and allow for tapering of steroid use. For refractory disease, biological therapy with agents blocking interleukin-1 (anakinra) and then those blocking interleukin-6 (tocilizumab) seem the most promising.
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Sánchez Atrio AI. [Systemic lupus erythematosus. Infrequent clinical aspects]. REUMATOLOGIA CLINICA 2008; 4 Suppl 1:28-30. [PMID: 21794550 DOI: 10.1016/s1699-258x(08)76136-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The SLE is a systemic autoimmune disease that presents a tremendous variability regarding its clinical presentation and immunologic expression. This disease can affect any organ, both as clinical onset or during the course of the disease. People in their second and third decade are most frequently affected, but the illness can debut at any age, with some different clinical peculiarities. SLE-associated clinical situations like hemophagocytic syndrome and some recently published clinical aspects like posterior reversible encephalopathy syndrome are reviewed here.
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Affiliation(s)
- Ana Isabel Sánchez Atrio
- Servicio de Enfermedades Sistémicas Autoinmunes/Reumatología. Hospital Universitario Príncipe de Asturias. Departamento de Medicina. Universidad de Alcalá. Alcalá de Henares. Madrid. España
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Affiliation(s)
- Hakan Gümüş
- Department of Pediatric Neurology, Erciyes University Faculty of Medicine, Kayseri, Turkey.
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Katoh N, Gono T, Mitsuhashi S, Fukushima K, Takei YI, Matsuda M, Ikeda SI. Hemophagocytic syndrome associated with rheumatoid arthritis. Intern Med 2007; 46:1809-13. [PMID: 17978540 DOI: 10.2169/internalmedicine.46.0396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a patient with rheumatoid arthritis (RA) who showed bicytopenia with hyperferritinemia and hepatic dysfunction ascribable to hemophagocytic syndrome (HPS) 2 weeks after commencement of bucillamine. Pathology of the bone marrow showing infiltration of macrophages confirmed the diagnosis of HPS. On the basis of renal dysfunction with an increase in fibrin degradation products, disseminated intravascular coagulation was considered to be concurrent with HPS. Oral prednisolone and cyclosporine A were started right after cessation of bucillamine, and yielded complete normalization of hepatic and renal function and hematology. As there was neither disease activity of RA nor associated infection throughout the clinical course, bucillamine was suspected of being the cause of HPS in our patient. HPS is a very rare complication in RA, but should be actively considered when abnormalities in laboratory data, especially pancytopenia and hepatic dysfunction, quickly worsen.
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Affiliation(s)
- Nagaaki Katoh
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
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Lambotte O, Khellaf M, Harmouche H, Bader-Meunier B, Manceron V, Goujard C, Amoura Z, Godeau B, Piette JC, Delfraissy JF. Characteristics and long-term outcome of 15 episodes of systemic lupus erythematosus-associated hemophagocytic syndrome. Medicine (Baltimore) 2006; 85:169-182. [PMID: 16721259 DOI: 10.1097/01.md.0000224708.62510.d1] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Reactive hemophagocytic syndrome (HS) occurs mainly in the setting of serious infections and lymphomas. HS can occur in the course of 2 active systemic diseases, without simultaneous infection: adult Still disease and systemic lupus erythematosus (SLE). Observations of specific lupus-associated HS are rare, and the long-term outcome of these patients with active SLE is unknown. We retrospectively studied 15 episodes of SLE-associated HS in 12 patients (10 women, 2 men) and noted the long-term outcome. HS occurred at a mean age of 25 years. All patients were febrile with >or=2 cytopenias, and bone marrow aspiration indicated hemophagocytosis. HS revealed SLE in 9 patients and recurred in 3. The main features of SLE-associated HS were a low frequency of hepatosplenomegaly, a high frequency of heart involvement (5 pericarditis, 4 myocarditis requiring transfer to intensive care unit), and a low C-reactive protein level (mean, 15 mg/L). Cutaneous-mucous symptoms of SLE, arthritis, and nephritis were present respectively in 8 (53%), 6 (40%), and 4 (27%) episodes, but symptoms of SLE were absent in 4 episodes at admission. All patients had anti-nuclear antibodies when the HS occurred. Anti-double-stranded DNA antibodies were present in 12 episodes. Treatment was steroids in 14 cases but cyclophosphamide was the only treatment able to control HS in 2 cases. All the cases of SLE-associated HS were controlled by the immunosuppressive regimen. Intravenous immunoglobulins seemed poorly effective. No infectious agent was found. Clinical presentations of the 23 patients with SLE-associated HS described in the literature were reviewed and were similar to those of the current series. The mean follow-up was 88 months (range, 7-240 mo). One patient died at 15 months (sepsis). Among the 5 patients with a follow-up >8 years, 4 always had active disease. During the follow-up of SLE, immunosuppressive drugs were added in 8 patients (cyclophosphamide in 7, azathioprine in 3, mycophenolate mofetil in 2) with significant adverse drug reactions. In the long-term, SLE-associated HS seems to define a severe SLE form with frequent flares, possible HS recurrences, and the need for prolonged immunosuppression.
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Affiliation(s)
- Olivier Lambotte
- From Department of Internal Medicine (OL, VM, CG, JFD) and Department of Pediatrics (BBM), Bicêtre University Hospital, AP-HP, Le Kremlin Bicêtre; Department of Internal Medicine (MK, BG), Henri Mondor University Hospital, AP-HP, Créteil; Department of Internal Medicine (ZA, JCP), Pitié-Salpêtrière University Hospital, AP-HP, Paris, France; and Department of Internal Medicine (HH), Ibn Sina Hospital, Rabat, Morocco
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Pradalier A, Teillet F, Molitor JL, Drappier JC. Syndrome d’activation macrophagique (syndrome d’hémophagocytose). ACTA ACUST UNITED AC 2004; 52:407-14. [PMID: 15336434 DOI: 10.1016/j.patbio.2003.12.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2003] [Accepted: 12/01/2003] [Indexed: 11/20/2022]
Abstract
Macrophage activation syndrome MAS describes the clinical, biological and histological symptoms related to a probably T lymphocytes/NK cell driven stimulation of macrophages with the consequence of a hemophagocytosis involving numerous organs, preferentially bone marrow, explaining the other term of "hemophagocytic syndrome". Clinical symptoms include cytopenia, multiple organ dysfunction, fever unresponsive to antibiotics, fatigue and rash. Infections (bacteria, virus or parasites), lymphoproliferative disorders, cancers, systemic diseases are the most prevalent triggers or etiologies of M.A.S. Evidence of haemaphagocytosis is obtained in the majority of cases with bone marrow specimens. In some cases haemophagocytosis can spare the bone marrow with involvement confined to other tissues such as liver and spleen. Very high levels of ferritine seem to correlate well with the presence of haemophagocytosis and is a possible marker for an early diagnosis. Early treatment initiation is mandatory. Corticosteroids, cytostatic drugs such as etoposide, cyclosporine A, plasmapherese, intravenous immunoglobulins and anti TNFalpha are proposed but no randomized trials were published.
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Affiliation(s)
- A Pradalier
- Service de médecine interne IV, centre d'allergie de l'ouest parisien, hôpital Louis-Mourier, 178, rue des Renouillers, 92700 Colombes, France.
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Yang YC, Jou ST, Chang YH, Liang JS, Lee WT. Hemophagocytic syndrome associated with antiepileptic drug. Pediatr Neurol 2004; 30:358-60. [PMID: 15165641 DOI: 10.1016/j.pediatrneurol.2003.12.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2003] [Accepted: 12/17/2003] [Indexed: 10/26/2022]
Abstract
An 8-year-3-month-old male with right porencephaly and epilepsy was found to have skin rash 2 weeks after the beginning of treatment with lamotrigine. One month later he suffered from impaired liver function and pancytopenia in the presence of hypocellular bone marrow with hemophagocytosis. No evidence of infection was evident. Intravenous immunoglobulin and steroid were administered with discontinuation of lamotrigine; the hemogram and liver function profile improved dramatically. Hemophagocytic syndrome should be considered a possible cause of pancytopenia in patients taking new antiepileptic drugs such as lamotrigine.
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Affiliation(s)
- Yu-Chun Yang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
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Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2002; 11:727-42. [PMID: 12512251 DOI: 10.1002/pds.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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