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Ali M, Sumbul M, Nadeem M. An Unusual Case of Phagocytic Histiocytes on Peripheral Blood Smear of a Patient With Methicillin-Resistant Staphylococcus aureus (MRSA) Endocarditis. Cureus 2023; 15:e49042. [PMID: 38116350 PMCID: PMC10729711 DOI: 10.7759/cureus.49042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/21/2023] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder of the immune system that may rapidly progress into life-threatening complications. There is uncontrolled activation of histiocytes and phagocytic macrophages, resulting in excess secretions of cytokines that manifest into systemic hyperinflammation affecting several organs. HLH may present as primary due to underlying familial or genetic causes or as secondary due to underlying conditions such as malignancies, infections, or autoimmune disorders. This case is of a seven-year-old girl who developed culture-proven MRSA infective endocarditis. She received sensitivity-tailored antimicrobial treatment. Initially unremarkable, but later her peripheral blood smear showed the presence of large histiocyte-like cells showing hemophagocytic activity of moderate grade (two to five histiocytes with hemophagocytosis/slide) on the feathered edge of the slide. Peripheral film findings triggered further workup for HLH. Her condition later deteriorated, requiring high-dependency unit care. This case highlights the significance of maintaining a high index of suspicion with subsequent laboratory work in cases that develop cardinal diagnostic criteria for clinical manifestations of HLH. It also emphasizes reviewing the feathered edges of blood smears to prevent overlooking important morphological findings.
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Affiliation(s)
- Maria Ali
- Hematology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Maliha Sumbul
- Hematology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Muhammad Nadeem
- Hematology, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, PAK
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Zhang J, Wang J, Gan J, Luo R, Chen X. The first case of Streptococcus intermedius brain abscess with hemophagocytic histiocytosis. BMC Infect Dis 2022; 22:627. [PMID: 35850669 PMCID: PMC9290246 DOI: 10.1186/s12879-022-07600-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/07/2022] [Indexed: 12/01/2022] Open
Abstract
Background Hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially life-threatening immune syndrome associated with an excessive systemic inflammatory response. Viral infection caused HLH is the most common secondary HLH, but there are relatively few reports of HLH caused by bacterial infection. The present study is the first case of HLH caused by Streptococcus intermedia meningitis. Case presentation The patient is an 11-year-old and 9-month-old boy. The main symptoms are fever, headache, and vomiting. The imaging finding of the brain is cerebritis and brain abscess. The cerebrospinal fluid (CSF) routine test showed increased nucleated cells, but the smear and culture of CSF were negative. The metagenomics next-generation sequencing (mNGS) of CSF detected Streptococcus intermedius, and the body temperature of the children returned to normal after antibiotic treatment according to etiology. One week later, the child developed fever again, with Kawasaki disease-like manifestations. After high-dose immunoglobulin therapy, the body temperature returned to normal again. The routine blood test showed a progressive decrease in leukocytes and platelets, and bone marrow biopsy detected histiocytes phagocytosed blood cells. Then infection-associated hemophagocytic syndrome (IAHS) was diagnosed, high-dose methylprednisolone and sequential therapy were given and the patient’s recovery was encouraging. Conclusions Our case shows that HLH can also be secondary to Streptococcus intermediate infection, and early bone marrow biopsy is the golden standard for HLH diagnosis. mNGS can improve the detection sensitivity for pathogens when traditional pathogenic tests are negative. Conventional chemotherapy regimens may not be required for IAHS when high-dose glucocorticoids and immunoglobulin therapy are effective.
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Affiliation(s)
- Jia Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, 610041, China.,Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Development and Maternal and Child Diseases of Sichuan Province, Chengdu, 610041, China
| | - Jianjun Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, 610041, China.,Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Development and Maternal and Child Diseases of Sichuan Province, Chengdu, 610041, China
| | - Jing Gan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, 610041, China.,Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Development and Maternal and Child Diseases of Sichuan Province, Chengdu, 610041, China
| | - Rong Luo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, 610041, China.,Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Development and Maternal and Child Diseases of Sichuan Province, Chengdu, 610041, China
| | - Xiaolu Chen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section Three, South Renmin Road, Chengdu, 610041, China. .,Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China. .,Key Laboratory of Development and Maternal and Child Diseases of Sichuan Province, Chengdu, 610041, China.
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