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Tabaja H, Kanj A, El Zein S, Comba IY, Chehab O, Mahmood M. A Review of Hemophagocytic Lymphohistiocytosis in Patients With HIV. Open Forum Infect Dis 2022; 9:ofac071. [PMID: 35308483 PMCID: PMC8926004 DOI: 10.1093/ofid/ofac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/10/2022] [Indexed: 11/23/2022] Open
Abstract
We provide an elaborate review of cases published between January 2005 and April 2021 on hemophagocytic lymphohistiocytosis (HLH) in HIV patients. Seventy articles describing 81 adult patients (age ≥19 years) were included. The median age was 40 years, and 78% were males. Only 65% were known to have HIV before presentation. CD4 count was ≥200 cells/mm3 in 23%, and HIV viral load was <200 copies/mL in 41%. The lack of meticulous reporting of ≥5 of 8 criteria for HLH diagnosis was evident in a third of cases. At least 1 infectious agent-other than HIV-was believed to trigger HLH in 78% of patients. The most common were Epstein-Barr virus (26%), human herpesvirus 8 (21%), and Histoplasma capsulatum (17%). Sixty percent survived. Among those, 93% received treatment for identified secondary trigger(s), while 51% received HLH-directed therapy. There was significant heterogeneity in the treatment regimens used for HLH.
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Affiliation(s)
- Hussam Tabaja
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Amjad Kanj
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Said El Zein
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Isin Yagmur Comba
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Omar Chehab
- Division of Internal Medicine, John Hopkins, Baltimore, Maryland, USA
| | - Maryam Mahmood
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Shi B, Chen M, Xia Z, Xiao S, Tang W, Qin C, Cheng Y, Huang T, Huang C, Li Y, Xu H. Hemophagocytic syndrome associated with Mycobacterium bovis in a patient with X-SCID: a case report. BMC Infect Dis 2020; 20:711. [PMID: 32993535 PMCID: PMC7525942 DOI: 10.1186/s12879-020-05421-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023] Open
Abstract
Background Mycobacterium bovis could infect patients with immunodeficiency or immunosuppressive conditions via Bacillus Calmette-Guérin (BCG) vaccination. Tuberculosis-related hemophagocytic syndrome (HPS) is reported, but not HPS caused by Mycobacterium bovis in children. Case presentation A 4-month Chinese boy presented fever and cough. The initial laboratory investigation showed the lymphocyte count of 0.97 × 109/L, which decreased gradually. HPS was diagnosed based on the test results that fulfilled the HLH-2004 criteria. In addition, Mycobacterium tuberculosis complex was detected from his peripheral blood via metagenomic next-generation sequencing (mNGS) and M. bovis was identified by polymerase chain reaction-reverse dot blot (PCR-RDB). Thus, the patient was treated with Isoniazid, Rifampin, and Pyrazinamide, but not improved. However, parents refused to accept further therapy, and was discharged on the day 12 of admission. To confirm the pathogenesis, genetic analysis was performed. Mutation in the interleukin-2 receptor subunit gamma gene: Exon 6: c.854G > A; p. Arg285Gln was detected in the patient and the mother, which could underlie X-linked severe combined immunodeficiency. Conclusions A boy with X-SCID was diagnosed with M. bovis-associated HPS, emphasizing that X-SCID should be considered when M. bovis is detected in a male infant with low lymphocyte counts.
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Affiliation(s)
- Buyun Shi
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Ming Chen
- Department of Dermatology, Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Zhi Xia
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Shuna Xiao
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Wen Tang
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Chenguang Qin
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Ying Cheng
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Tao Huang
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Chengjiao Huang
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Yong Li
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Hui Xu
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China.
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González-Hernández LA, Alvarez-Zavala M, Cabrera-Silva RI, Martínez-Ayala P, Amador-Lara F, Ramírez-González AS, Ron-Magaña AL, Ruiz Herrera VV, Sánchez-Reyes K, Andrade-Villanueva JF. Cytomegalovirus and disseminated histoplasmosis-related hemophagocytic lymphohistiocytosis syndrome in an HIV-patient late presenter with IRIS: a case report. AIDS Res Ther 2020; 17:52. [PMID: 32795368 PMCID: PMC7427876 DOI: 10.1186/s12981-020-00304-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 07/22/2020] [Indexed: 11/13/2022] Open
Abstract
Background Hemophagocytic lymphohistiocytosis syndrome (HLS) is an immune-mediated life-threatening disease considered as a medical emergency, with a potentially fatal multisystem inflammatory outcome. We present a patient that developed HLS and was able to be diagnosed efficiently with the help of an academic research institute of immunology. Case presentation A 21 years old male Mexican with human immunodeficiency virus (HIV), late presenter; who developed cytomegalovirus (CMV) infection and a disseminated histoplasmosis-related HLS, as part of an immune reconstitution inflammatory syndrome (IRIS). The patient required a long course of corticotherapy, intravenous immunoglobulin and massive transfusions (more than 10 units in 24 h, and a total of 83 units), besides amphotericin-B and ganciclovir treatment. An academic research institute of immunology aided in the accurate diagnosis of HLS with the implementation of tests not available within the hospital, thus improving the care provided to the patient. The patient recovered, was discharged, and continue to improve. Conclusion The objective of this report is to highlight the importance of having multidisciplinary support, including basic medical sciences groups providing specific tests that are sometimes very difficult to get, which provides a benefit to patients in the well-aimed diagnosis as part of applied translational medicine.
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Egge SL, Cheeti A, Hayat S. Acute human immunodeficiency virus infection associated hemophagocytic lymphohistiocytosis. IDCases 2020; 21:e00861. [PMID: 32528850 PMCID: PMC7281787 DOI: 10.1016/j.idcr.2020.e00861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 05/30/2020] [Accepted: 05/30/2020] [Indexed: 11/21/2022] Open
Abstract
Although acute HIV-induced HLH is rare in literature, HIV is an important differential diagnosis in patients with HLH. In our study, a 33-year-old previously healthy male patient was admitted with fever of unknown origin, lymphadenopathy, generalized edema, transaminitis, acute renal failure, oliguria, myalgias, night sweats, unintentional weight loss, and leukopenia. Disease course was indicative of a viral-like prodrome of roughly 2-month duration. At an outside hospital, full viral work-up (including EBV, CMV, HIV antibodies, hepatitis panel) was negative. HIV p24 antigen assay was not available at the outside facility. Outside liver chemistry and lymph node biopsy were suggestive of HLH. HLH was confirmed via serum ferritin, white cell receptor, and cytokine studies. Repeat viral and rheumatologic studies revealed a positive p24 antigen with indeterminant HIV antibody. We demonstrate efficacy of a specific treatment plan as well as importance of p24 antigen studies in patients with HLH and/or the HIV window-period, adding to available literature/documentation of a rare disease process.
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Key Words
- AIDS, aquired immunodeficiency syndrome
- AKI, acute kidney injury
- ALP, alkaline phosphatase
- ALT, alanine transaminase
- ART, anti-retroviral therapy
- AST, aspartate transaminase
- ATN, Acute tubular necrosis
- Acquired immunodeficiency syndrome
- Aids
- CMV, cytomegalovirus
- Cytokine storm
- FTA-ABS, Fluorescent treponemal antibody
- Fever of unknown origin
- Fuo
- HHV, human herpes virus
- HIV, human immunodeficiency virus
- HIVAN, HIV-associated nephropathy
- HLH, hemophagocytosis lymphohistiocytosis
- HSV, herpes simplex virus
- Hemophagocytic lymphohistiocytosis
- Hiv
- Hlh
- Human immunodeficiency virus
- IVIG, intravenous immunoglobulin
- RPR, rapid plasma regain
- Transaminitis
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Affiliation(s)
- Stephanie L Egge
- Louisiana State University Health Sciences Center, Department of Internal Medicine, Shreveport, LA, United States
| | - Apoorva Cheeti
- Louisiana State University Health Sciences Center, Department of Internal Medicine, Shreveport, LA, United States
| | - Samina Hayat
- Louisiana State University Health Sciences Center, Department of Internal Medicine, Shreveport, LA, United States.,Louisiana State University Health Sciences Center, Department of Rheumatology, Shreveport, LA, United States
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