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Meazza Prina M, Martini F, Bracchi F, Di Mauro D, Fargnoli A, Motta M, Giussani C, Gobbin G, Taverna M, D'Alessio A. Hemophagocytic syndrome secondary to SARS-Cov-2 infection: a case report. BMC Infect Dis 2021; 21:811. [PMID: 34388982 PMCID: PMC8361241 DOI: 10.1186/s12879-021-06532-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Hemophagocytic syndrome (HPS) is a severe hyperinflammatory disease, whose diagnosis is based on the HLH-2004 criteria. In secondary forms of HLH (sHLH), the primary goal is treating the triggering factors such as COVID-19 (Coronavirus disease 2019). The link between the cytokine storm related to COVID-19 and development of sHLH has already been reported since the onset of pandemic, but little is known about clinical manifestations of HLH which develop after the patient’s recovery from mild symptomatic or asymptomatic Sars-CoV-2 infection. Case presentation We describe the case of a woman diagnosed with sHLH related to previous Sars-CoV-2 infection and successfully treated with steroids, colchicine, etoposide and ruxolitinib. Conclusions Our report suggests that HLH-like syndrome might be secondary to Sars-CoV-2 infection, even if the patient utterly recovered from the mildly symptomatic viral infection. In addition, we underline the treatment with low dose ruxolitinib plus etoposide as a potential choice for Sars-CoV-2 infection related HLH.
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Affiliation(s)
- Marco Meazza Prina
- Department of Internal Medicine and Onco-Haematology Policlinico S.Marco, GSD University and Research Hospital, Corso Europa 7, 24040, Zingonia, BG, Italy
| | - Francesca Martini
- Department of Internal Medicine and Onco-Haematology Policlinico S.Marco, GSD University and Research Hospital, Corso Europa 7, 24040, Zingonia, BG, Italy.
| | - Federico Bracchi
- Department of Internal Medicine and Onco-Haematology Policlinico S.Marco, GSD University and Research Hospital, Corso Europa 7, 24040, Zingonia, BG, Italy
| | - Daniela Di Mauro
- Department of Internal Medicine and Onco-Haematology Policlinico S.Marco, GSD University and Research Hospital, Corso Europa 7, 24040, Zingonia, BG, Italy
| | - Anna Fargnoli
- Department of Internal Medicine and Onco-Haematology Policlinico S.Marco, GSD University and Research Hospital, Corso Europa 7, 24040, Zingonia, BG, Italy
| | - Marco Motta
- Department of Internal Medicine and Onco-Haematology Policlinico S.Marco, GSD University and Research Hospital, Corso Europa 7, 24040, Zingonia, BG, Italy
| | - Cristina Giussani
- Department of Internal Medicine and Onco-Haematology Policlinico S.Marco, GSD University and Research Hospital, Corso Europa 7, 24040, Zingonia, BG, Italy
| | - Giovanni Gobbin
- Department of Internal Medicine and Onco-Haematology Policlinico S.Marco, GSD University and Research Hospital, Corso Europa 7, 24040, Zingonia, BG, Italy
| | - Monica Taverna
- Department of Internal Medicine and Onco-Haematology Policlinico S.Marco, GSD University and Research Hospital, Corso Europa 7, 24040, Zingonia, BG, Italy
| | - Andrea D'Alessio
- Department of Internal Medicine and Onco-Haematology Policlinico S.Marco, GSD University and Research Hospital, Corso Europa 7, 24040, Zingonia, BG, Italy
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D'Alessio A, Del Poggio P, Bracchi F, Cesana G, Sertori N, Di Mauro D, Fargnoli A, Motta M, Giussani C, Moro P, Vitale G, Giacomini M, Borra G. Low-dose ruxolitinib plus steroid in severe SARS-CoV-2 pneumonia. Leukemia 2021; 35:635-638. [PMID: 33173161 PMCID: PMC7654848 DOI: 10.1038/s41375-020-01087-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/31/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023]
Affiliation(s)
- A D'Alessio
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - P Del Poggio
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy.
| | - F Bracchi
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - G Cesana
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - N Sertori
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - D Di Mauro
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - A Fargnoli
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - M Motta
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - C Giussani
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - P Moro
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - G Vitale
- Intensive Care Unit, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - M Giacomini
- Intensive Care Unit, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - G Borra
- Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
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Martini F, D’Alessio A, Bracchi F, Di Mauro D, Fargnoli A, Motta M, Giussani C, Meazza Prina M, Gobbin G, Taverna M. On Cancer, COVID-19, and CT Scans: A Monocentric Retrospective Study. J Clin Med 2020; 9:E3935. [PMID: 33291710 PMCID: PMC7761962 DOI: 10.3390/jcm9123935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/28/2020] [Accepted: 12/02/2020] [Indexed: 12/19/2022] Open
Abstract
Background The use of computed tomography (CT) for coronavirus disease 2019 (COVID-19) diagnosis in an area of northern Italy with a high incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may have identified more patients with this disease than RT-PCR in the very early onset of the COVID-19 pandemic. Methods We retrospectively reviewed 148 chest CT scans of oncological patients who were referred to the Radiological Unit of Policlinico S. Marco from 1 February 2020 to 30 April 2020, during the COVID-19 outbreak in Bergamo area. In parallel, we analyzed RT-PCR tests of these 148 patients. Results Among 32 patients with a diagnosis of COVID-19, 17 patients were asymptomatic or had mild symptoms (53.1%), while 15 developed severe disease (46.8%). The incidence of SARS-CoV-2 infection was 22.9%, the mortality rate was 18.8%. We did not find any correlation between disease severity and age, sex, smoking, or cardiovascular comorbidities. Remarkably, patients who were on treatment for cancer developed a milder disease than patients who were not on treatment. Conclusions The acceptance of CT-defined diagnoses in COVID-19 high-incidence areas like Bergamo region highlighted a larger oncological population affected by COVID-19 than RT-PCR, in particular, asymptomatic and mildly symptomatic patients, because only symptomatic patients underwent nasopharyngeal swabbing at the onset of the COVID-19 pandemic. We observed that patients actively treated for their cancer had a milder disease, in agreement with previous studies that suggested a protective role of immunosuppression. Admittedly, the sample of patients in our study was heterogeneous regarding the oncological disease, their prognosis, and the type of treatment; therefore, other studies are needed to confirm our data.
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Affiliation(s)
- Francesca Martini
- Department of Internal Medicine and Onco-Haematology, Policlinico S. Marco, 24040 Bergamo, Italy; (A.D.); (F.B.); (D.D.M.); (A.F.); (M.M.); (C.G.); (M.M.P.); (G.G.); (M.T.)
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Vicentini A, Masiello L, D’Amore S, Baldi E, Ghio S, Savastano S, Sanzo A, Di Matteo A, Seminari EM, Lenti MV, Bosio M, Petracci B, Frigerio L, Sabena A, Tavazzi G, Oltrona Visconti L, Rordorf R, Gnecchi M, Totaro R, Ferlini M, Greco A, Magrini G, Scelsi L, Acquaro M, Coccia M, Digiacomo S, Foglia D, Jeva F, Montalto C, Moschella M, Pezza L, Perlini S, Alfano C, Bonzano M, Briganti F, Crescenzi G, Falchi AG, Maggi E, Guarnone R, Guglielmana B, Martino IF, Pioli Di Marco MS, Pettenazza P, Quaglia F, Salinaro F, Speciale F, Zunino I, Sturniolo G, Bracchi F, Lago E, Corsico A, Piloni D, Accordino G, Burattini C, Di Sabatino A, Pellegrino I, Soriano S, Santacroce G, Parodi A, de Andreis FB, Bruno R, Zuccaro V, Moioli F, Dammassi V, Albertini R. QTc Interval and Mortality in a Population of SARS-2-CoV Infected Patients. Circ Arrhythm Electrophysiol 2020; 13:e008890. [DOI: 10.1161/circep.120.008890] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Alessandro Vicentini
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lucrezia Masiello
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, Cardiology Unit (L.M., S.D., E.B.), University of Pavia, Italy
| | - Sabato D’Amore
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, Cardiology Unit (L.M., S.D., E.B.), University of Pavia, Italy
| | - Enrico Baldi
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, Cardiology Unit (L.M., S.D., E.B.), University of Pavia, Italy
| | - Stefano Ghio
- Division of Cardiology (S.G., S.S., L.O.V.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simone Savastano
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Sanzo
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Emergency Department (A.S.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine (A.S.), University of Pavia, Italy
| | - Angela Di Matteo
- Division of Infectious Disease (A.D.M., E.M.S.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elena Maria Seminari
- Division of Infectious Disease (A.D.M., E.M.S.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine (M.V.L.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Bosio
- Division of Respiratory Diseases (M.B.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Barbara Petracci
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Laura Frigerio
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Anna Sabena
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Guido Tavazzi
- Anaesthesia and Intensive Care (G.T.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of Anesthesia and Intensive Care (G.T.), University of Pavia, Italy
| | - Luigi Oltrona Visconti
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Laboratory of Clinical and Experimental Cardiology (A.V., L.M., S.D., E.B., A.S., B.P., L.F., R.R.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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