1
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Bris PN, Gauchez P, Devillier R, Galicier L, Collignon A, Piana G, Poizat F, Faucher M, Hospital MA, Vey N, Gonzalez F, Servan L, Chow-Chine L, Sannini A, Mokart D, Saillard C, Bisbal M. Hepatic haemophagocytosis in haematology patients with hepatic dysfunction: prognostic impact and contribution of liver biopsy combined with the haemophagocytic syndrome diagnostic score (HScore). Br J Haematol 2022; 199:106-116. [PMID: 35968907 DOI: 10.1111/bjh.18382] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 01/07/2023]
Abstract
Hepatic dysfunction (HD) is common in patients with haematological malignancies. Hepatic haemophagocytosis (HH) was detected in >50% of liver biopsies taken when HD remained unresolved after standard examination. We aimed to explore the contribution of liver biopsy in patients with both haematological malignancies and HD, describe the population of patients with HH, assess the prognostic impact of HH, and investigate haemophagocytic syndrome diagnostic score (HScore) utility in patients with HH. Between 2016 and 2019, 116 consecutive liver biopsies (76 transjugular, 40 percutaneous) were taken in 110 patients with haematological malignancy and HD (hyperbilirubinaemia, elevated transaminases, and/or cholestasis) and without a clear diagnosis. Liver biopsies were safe and diagnostically efficient. Predominant diagnoses included: HH (56%), graft-versus-host disease (55%), associated infections (24%), sinusoidal obstruction syndrome (15%), and tumoral infiltration (8%). Of patients, 35% were critically ill and 74% were allogeneic haematopoietic stem cell transplantation recipients, while 1-year overall survival (OS) was 35% with HH versus 58% without HH (p = 0.026). The 1-year OS was 24% with a HScore of ≥169 versus 50% with a HScore of <169 (p = 0.019). Liver biopsies are feasible in and contribute significantly to haematology patients with HD. HH occurred frequently and was associated with a poor prognosis. Combined with liver biopsy, the HScore may be helpful in refining haemophagocytic syndrome diagnosis.
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Affiliation(s)
- Pierre-Nicolas Bris
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Philippe Gauchez
- Pathology Department, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, France
| | | | | | - Aude Collignon
- Hematology Department, Institut Paoli Calmettes, Marseille, France
| | - Gilles Piana
- Imagery Department, Institut Paoli Calmettes, Marseille, France
| | - Flora Poizat
- Pathology Department, Institut Paoli Calmettes, Marseille, France
| | - Marion Faucher
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | | | - Norbert Vey
- Hematology Department, Institut Paoli Calmettes, Marseille, France.,Aix-Marseille University, Marseille, France
| | - Frederic Gonzalez
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Luca Servan
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Laurent Chow-Chine
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Antoine Sannini
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Djamel Mokart
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Colombe Saillard
- Hematology Department, Institut Paoli Calmettes, Marseille, France
| | - Magali Bisbal
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
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2
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Sangha G, Kaushik K, Robinson A, Ainge T, Dungarwalla M, Chakraborty A. Limited utility of the HScore in detecting secondary haemophagocytic lymphohistiocytosis in COVID-19. Br J Haematol 2021; 194:686-688. [PMID: 33993500 DOI: 10.1111/bjh.17533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Gina Sangha
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Kunaal Kaushik
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | | | - Thomas Ainge
- Milton Keynes University Hospital, Milton Keynes, UK
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3
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Debliquis A, Harzallah I, Mootien JY, Poidevin A, Labro G, Mejri A, Lamarque M, Kuteifan K, Drénou B. Haemophagocytosis in bone marrow aspirates in patients with COVID-19. Br J Haematol 2020; 190:e70-e73. [PMID: 32529634 PMCID: PMC7307071 DOI: 10.1111/bjh.16860] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Agathe Debliquis
- Département d'Hématologie, Groupe Hospitalier de la région Mulhouse Sud Alsace, Mulhouse, France
| | - Inès Harzallah
- Département d'Hématologie, Groupe Hospitalier de la région Mulhouse Sud Alsace, Mulhouse, France
| | - Joy Y Mootien
- Service de Réanimation médicale, Groupe Hospitalier de la région Mulhouse Sud Alsace, Mulhouse, France
| | - Antoine Poidevin
- Service de Réanimation médicale, Groupe Hospitalier de la région Mulhouse Sud Alsace, Mulhouse, France
| | - Guylaine Labro
- Service de Réanimation médicale, Groupe Hospitalier de la région Mulhouse Sud Alsace, Mulhouse, France
| | - Amira Mejri
- Département d'Hématologie, Groupe Hospitalier de la région Mulhouse Sud Alsace, Mulhouse, France
| | - Mathilde Lamarque
- Département d'Hématologie, Groupe Hospitalier de la région Mulhouse Sud Alsace, Mulhouse, France
| | - Khaldoun Kuteifan
- Service de Réanimation médicale, Groupe Hospitalier de la région Mulhouse Sud Alsace, Mulhouse, France
| | - Bernard Drénou
- Département d'Hématologie, Groupe Hospitalier de la région Mulhouse Sud Alsace, Mulhouse, France
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4
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Day JW, Fox TA, Halsey R, Carpenter B, Kottaridis PD. Interleukin-1 blockade with anakinra in acute leukaemia patients with severe COVID-19 pneumonia appears safe and may result in clinical improvement. Br J Haematol 2020; 190:e80-e83. [PMID: 32438450 PMCID: PMC7280623 DOI: 10.1111/bjh.16873] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- James W Day
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK.,UCL Institute of Immunity and Transplantation, UCL, London, UK
| | - Thomas A Fox
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK.,UCL Institute of Immunity and Transplantation, UCL, London, UK
| | - Richard Halsey
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ben Carpenter
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Panagiotis D Kottaridis
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
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5
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Contreras-Chavez P, Anampa-Guzmán A, Gaznabi S, Lansigan F. Epstein-Barr Virus Infection-associated Hemophagocytic Lymphohistiocytosis. Cureus 2020; 12:e7563. [PMID: 32382465 PMCID: PMC7202582 DOI: 10.7759/cureus.7563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening syndrome characterized by uncontrolled immune activation. There is an aberrant activation of lym-phocytes and macrophages that results in hypercytokinemia. We aim to describe a case of secondary HLH due to primary Epstein-Barr virus (EBV) infection. A Hispanic 28-year-old man presented with sore throat and fatigue for one week. He was diagnosed with mononucleosis and discharged and was treated according to the currently available treatment. HLH is treated by diminishing the inflammation by myelosuppressive and immunosuppressive therapy. EBV infection-associated HLH is a rare disease with high mortality. It is crucial to think about it when facing a patient with fever, cytopenia, hepatosplenomegaly, and high levels of ferritin. Despite medical treatment, the patient died from multiorgan failure.
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Affiliation(s)
| | | | - Safwan Gaznabi
- Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, USA
| | - Frederick Lansigan
- Hematology, Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, USA
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6
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Sato S, Uejima Y, Arakawa Y, Furuichi M, Suganuma E, Fujinaga S, Nakazawa A, Kawano Y. Clinical features of macrophage activation syndrome as the onset manifestation of juvenile systemic lupus erythematosus. Rheumatol Adv Pract 2019; 3:rkz013. [PMID: 31432001 PMCID: PMC6649928 DOI: 10.1093/rap/rkz013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/24/2019] [Indexed: 01/01/2023] Open
Abstract
Objectives Macrophage activation syndrome (MAS) is a severe complication of juvenile systemic lupus erythematosus (jSLE). However, little is known about the association between these conditions, especially in terms of MAS as the initial manifestation of jSLE. The aim of this study was to determine the clinical features of MAS as the initial manifestation of jSLE. Methods We carried out a retrospective review of the clinical features of MAS cases diagnosed concomitantly with jSLE from 2004 to 2016. Data from these patients were compared with those from a control group consisting of jSLE patients without MAS. Results Eleven (23.9%) of the 46 patients recruited for this study were diagnosed with MAS during the initial stage of jSLE. The between-group comparisons demonstrated that fever, leucopenia, hyperferritinaemia and increased aspartate aminotransferase were more frequently observed in jSLE patients with MAS than in controls (P<0.01). Importantly, neurological symptoms were significantly more common in patients with MAS than in controls (P<0.01), with 6 (54.6%) of the 11 MAS patients affected. For treatment, all 11 patients with both jSLE and MAS were administered CSs upon diagnosis, and 7 received immunosuppressants. No patient involved in this study died. Conclusion MAS can develop as the initial manifestation of jSLE. MAS with jSLE should be suspected in patients with fever, hyperferritinaemia, cytopenia and liver disorder. In addition, we found that jSLE patients with MAS had more neurological symptoms than those without. All patients with MAS were successfully treated with CSs. Early diagnosis and intensive therapy are essential in improving clinical outcomes.
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Affiliation(s)
| | - Yoji Uejima
- Division of Infectious Diseases and Immunology
| | | | | | | | | | - Atsuko Nakazawa
- Division of Pathology, Saitama Children's Medical Center, Saitama, Japan
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7
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Tascini G, Lanciotti L, Sebastiani L, Paglino A, Esposito S. Complex Investigation of a Pediatric Haematological Case: Haemophagocytic Syndrome Associated with Visceral Leishmaniasis and Epstein⁻Barr (EBV) Co-Infection. Int J Environ Res Public Health 2018; 15:E2672. [PMID: 30486459 DOI: 10.3390/ijerph15122672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Visceral leishmaniasis (VL) is an anthropozoonosis caused by an intracellular parasite belonging to the genus Leishmania. In the Mediterranean region, L. donovani and L. infantum are responsible for VL and dogs are the main reservoir. Haemophagocytic lymphohistiocytosis (HLH) represents a complication of VL and consists of unrestrained activation and proliferation of lymphocytes and macrophages, leading to uncontrolled immune activation. Haemophagocytic lymphohistiocytosis may also develop during viral infection, and Epstein⁻Barr virus (EBV) infection is one of the main HLH causes. Macrophage haemophagocytosis in the bone marrow aspirate is pathognomonic. CASE PRESENTATION The case involves a 19-month-old male infant presenting with a high persistent fever with a fluctuating pattern, pancytopaenia, hepatosplenomegaly, and a high triglyceride level. Initial investigations showed an EBV infection. Considering the persistent signs and symptoms, bone marrow aspiration was performed and confirmed the suspicion of HLH. In addition, the presence of Leishmania infection was shown. The patient was treated with liposomal amphotericin B and had complete resolution of his symptoms. CONCLUSION Diagnosis of VL represents a demanding challenge in endemic and non-endemic areas. Our case demonstrates that leishmaniasis should always be considered in the differential diagnosis in patients presenting with hepatosplenomegaly and cytopaenia with a persistent fever, even in cases of infectious mononucleosis. Moreover, the execution of bone marrow aspiration should not be delayed in order to diagnose and treat at an early stage the potential occurrence of VL, especially if complicated with HLH.
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8
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Chen LYC, Hayden A, Mattman A. Extreme hyperferritinaemia, soluble interleukin-2 receptor, and haemophagocytic lymphohistiocytosis. Br J Haematol 2018; 185:605-606. [PMID: 30203837 DOI: 10.1111/bjh.15579] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Luke Y C Chen
- Division of Hematology, University of British Columbia, Vancouver, Canada
| | - Anna Hayden
- Division of Hematology, University of British Columbia, Vancouver, Canada
| | - Andre Mattman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
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9
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Bigenwald C, Fardet L, Coppo P, Meignin V, Lazure T, Fabiani B, Kohn M, Oksenhendler E, Boutboul D, Uzzan M, Lambotte O, Galicier L. A comprehensive analysis of Lymphoma-associated haemophagocytic syndrome in a large French multicentre cohort detects some clues to improve prognosis. Br J Haematol 2018; 183:68-75. [PMID: 30043391 DOI: 10.1111/bjh.15506] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/07/2018] [Indexed: 12/14/2022]
Abstract
Lymphoma-associated haemophagocytic syndrome (LAHS) accounts for most cases of secondary haemophagocytic syndrome (HS) and has been extensively described in Asian populations. However, little is known about the epidemiology of LAHS in Western countries. We herein report a case series of 71 LAHS patients in which the lymphomas were mainly of the aggressive type. Diagnoses included non-Hodgkin B cell lymphoma (46·5%) including human herpes virus 8-associated non-Hodgkin lymphoma (12·7%), T cell lymphoma (28·2%) and Hodgkin lymphoma (23·9%). An underlying immunodeficiency was described in 30 patients (42·3%). Early mortality within the 30 days following HS diagnosis was observed in 26·8% of cases. The overall survival was estimated at 45·7% [95% confidence interval, CI (35·4-59·0)] at 6 months, and 34·3% [95% CI (24·8-47·4)] at 2 years. Concurrent infection, age over 50 years, ethnicity and etoposide treatment were independently associated with mortality. While it appears that certain types of lymphomas were more prone to trigger HS, LAHS were not restricted to a few types of lymphoma. The overall prognosis was poor, with a particularly high rate of early mortality, highlighting the importance of both early recognition and choice of initial therapeutic management.
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Affiliation(s)
- Camille Bigenwald
- Department of Clinical Immunology, Hopital Saint-Louis, Assistance Publique Hopitaux de Paris (APHP), Paris, France
| | - Laurence Fardet
- EA3518, Université Paris Diderot Paris 7, Paris, France.,Department of Dermatology, Hopital Henri-Mondor, APHP, Paris, France
| | - Paul Coppo
- EA7379, Université Paris Est Créteil, Paris, France
| | - Véronique Meignin
- Department of Hematology, Hopital Saint Antoine, APHP, Paris, France
| | - Thierry Lazure
- Department of Pathology, Hopital Saint-Louis, APHP, Paris, France
| | - Bettina Fabiani
- Department of Pathology, Hopital Bicetre, APHP, Paris, France
| | - Milena Kohn
- Department of Clinical Immunology, Hopital Saint-Louis, Assistance Publique Hopitaux de Paris (APHP), Paris, France
| | - Eric Oksenhendler
- Department of Clinical Immunology, Hopital Saint-Louis, Assistance Publique Hopitaux de Paris (APHP), Paris, France.,Department of Pathology, Hopital Saint-Antoine, APHP, Paris, France
| | - David Boutboul
- Department of Clinical Immunology, Hopital Saint-Louis, Assistance Publique Hopitaux de Paris (APHP), Paris, France
| | - Mathieu Uzzan
- Department of Clinical Immunology, Hopital Saint-Louis, Assistance Publique Hopitaux de Paris (APHP), Paris, France
| | - Olivier Lambotte
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, Le Kremlin-Bicêtre, France.,INSERM U1184, Immunology of Viral Infections and Antoimmune diseases, Le Kremlin-Bicêtre, France.,Université Paris Sud, Le Kremlin-Bicêtre, France.,CEA, DSV/iMETI, IDMIT, Fontenay-aux-Roses, France
| | - Lionel Galicier
- Department of Clinical Immunology, Hopital Saint-Louis, Assistance Publique Hopitaux de Paris (APHP), Paris, France.,EA3518, Université Paris Diderot Paris 7, Paris, France
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10
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Hussain S, Hallam S, Beltran L, Haroon A, Majumdar K, Shamash J, Sivapackianathan R, Drake W. Intravascular large B-cell lymphoma presenting as a pituitary mass with bilateral adrenal enlargement and haemophagocytic lymphohistiocytosis. Br J Haematol 2017; 181:851-852. [PMID: 28439895 DOI: 10.1111/bjh.14715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Shazia Hussain
- Department of Endocrinology, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Simon Hallam
- Department of Haemato-oncology, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Luis Beltran
- Department of Cellular Pathology, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Athar Haroon
- Department of Radiology, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Kalpita Majumdar
- Department of Endocrinology, Whipps Cross Hospital, Barts Health NHS Trust, London, UK
| | - Jonathan Shamash
- Department of Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Rasheeta Sivapackianathan
- Department of Endocrinology, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - William Drake
- Department of Endocrinology, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
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11
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Abstract
We report a case of expanded dengue syndrome, where three uncommon presentations occurred concomitantly. A patient with dengue haemorrhagic fever presented initially with acute acalculous cholecystitis along with acute pancreatitis, but later on, during resolution of pancreatitis and cholecystitis, developed pancytopenia, most likely due to haemophagocytic syndrome. Such presentations, besides being rare themselves, have not been reported to occur concomitantly, in the same patient, during the same disease process.
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Affiliation(s)
| | - Raihan Rabbani
- 2 Consultant, ICU, Square Hospitals Ltd., Dhaka, Bangladesh
| | - Farzana Shumy
- 3 Medical Officer, Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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12
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Abstract
Haemophagocytic syndrome, or haemophagocytic lymphohistiocytosis (HLH), is a hyperinflammatory disorder characterised by uncontrolled activation of the immune system. It can result from mutations in multiple genes involved in cytotoxicity or occur secondary to a range of infections, malignancies or autoimmune rheumatic diseases. In the latter case, it is also known as macrophage activation syndrome (MAS). Characteristic features are persistent fever, hepatosplenomegaly, petechial/purpuric rash, progressive cytopenias, coagulopathy, transaminitis, raised C reactive protein, falling erythrocyte sedimentation rate, hypertriglyceridaemia, hypofibrinogenaemia and extreme hyperferritinaemia often associated with multi-organ impairment. Distinguishing HLH from systemic sepsis can present a major challenge. Criteria for diagnosis and classification of HLH and MAS are available and a serum ferritin >10 000 µg/L is strongly supportive of HLH. Without early recognition and appropriate treatment, HLH is almost universally fatal. However, with prompt referral and advancements in treatment over the past two decades, outcomes have greatly improved.
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Affiliation(s)
- Ethan S Sen
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
| | - Colin G Steward
- Department of Paediatric Haematology, Oncology and Bone Marrow Transplantation, Bristol Royal Hospital for Children, Bristol, UK
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13
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Abstract
Haemophagocytic lymphohistiocytosis is a rare inflammatory condition. It can present in adult general medical patients and is a challenging diagnostic conundrum. This article provides an overview of the pathophysiology and clinical presentation of the syndrome for the general physician who will be rarely confronted with this problem but will have to act promptly when the situation arises. Treatment is also briefly discussed, although this usually occurs in a specialist setting after the diagnosis has been established.
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14
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Brisse E, Matthys P, Wouters CH. Understanding the spectrum of haemophagocytic lymphohistiocytosis: update on diagnostic challenges and therapeutic options. Br J Haematol 2016; 174:175-87. [PMID: 27292929 DOI: 10.1111/bjh.14144] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The cytokine storm syndrome 'haemophagocytic lymphohistiocytosis' (HLH) is an under-recognized hyperinflammatory disorder, causing high morbidity and mortality risk in children and adults. It can be subdivided into a primary, genetic form and a secondary, acquired form that complicates diverse infections, malignancies and autoimmune or autoinflammatory disorders. Both subtypes present with the same spectrum of non-specific symptoms, making accurate diagnosis and rapid treatment initiation challenging. In the last decade, increased awareness and international collaborative efforts fuelled a marked progress in diagnostic protocols and novel treatment strategies for HLH and new diagnostic guidelines are being tailored to specific secondary HLH subtypes. Therapy is gradually shifting its focus from overall immunosuppression towards targeting specific cytokines, cell types or signalling pathways underlying pathophysiology. Nevertheless, continued research efforts remain indispensable to customize therapy to individual patient needs.
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Affiliation(s)
- Ellen Brisse
- Laboratory of Immunobiology, Rega Institute, KU Leuven, Leuven, Belgium
| | - Patrick Matthys
- Laboratory of Immunobiology, Rega Institute, KU Leuven, Leuven, Belgium
| | - Carine H Wouters
- Laboratory of Paediatric Immunology, KU Leuven, University Hospital Gasthuisberg, Leuven, Belgium
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15
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Ikawa Y, Nishimura R, Araki R, Noguchi K, Muraoka M, Fukuda M, Fujiki T, Kuroda R, Mase S, Maeba H, Nomura K, Yachie A. Pathognomonic serum cytokine profiles identify life-threatening langerhans cell histiocytosis. Br J Haematol 2016; 176:495-497. [PMID: 27062281 DOI: 10.1111/bjh.13970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Yasuhiro Ikawa
- Department of Paediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Ryosei Nishimura
- Department of Paediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Raita Araki
- Department of Paediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Kazuhiro Noguchi
- Department of Paediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Masahiro Muraoka
- Department of Paediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Masaki Fukuda
- Department of Paediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Toshihiro Fujiki
- Department of Paediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Rie Kuroda
- Department of Paediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Shintaro Mase
- Department of Paediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Hideaki Maeba
- Department of Paediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Keiko Nomura
- Department of Paediatrics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Akihiro Yachie
- Department of Paediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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16
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Arca M, Fardet L, Galicier L, Rivière S, Marzac C, Aumont C, Lambotte O, Coppo P. Prognostic factors of early death in a cohort of 162 adult haemophagocytic syndrome: impact of triggering disease and early treatment with etoposide. Br J Haematol 2014; 168:63-8. [PMID: 25157895 DOI: 10.1111/bjh.13102] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 07/29/2014] [Indexed: 12/14/2022]
Abstract
Reactive haemophagocytic syndrome is a life-threatening disease for which factors influencing the outcome remain unclear. We sought to identify determinants of early mortality in patients with reactive haemophagocytic syndrome by conducting a non-interventional retrospective multicentre study in three tertiary care teaching hospitals over a 6-year period. The medical files of 162 patients fulfilling our diagnostic criteria of haemophagocytic syndrome were reviewed. Patients were classified according to 30-d outcome following diagnosis. Thirty-three patients (20·4%) died within 30 d. Clinical features at diagnosis associated with 30-d death in univariate analysis were older age (P = 0·004), underlying lymphoma (P = 0·04), lower platelet count (P = 0·001) and elevated aspartate aminotransferase and lactate dehydrogenase (P = 0·04 both). The use of etoposide as a first-line treatment tended to be associated with a better outcome (P = 0·079). In multivariate analyses, increasing age, decreasing platelet count, underlying lymphoma and no etoposide in the management were associated with a poorer prognosis (P = 0·03, 0·01, 0·003 and 0·04, respectively). These prognostic factors could help to identify those patients more severely affected by reactive haemophagocytic syndrome, who should benefit from aggressive supportive care, combined with specific treatment of the precipitating factor.
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Affiliation(s)
- Marc Arca
- Service d'Hématologie Pédiatrique, Caen, France
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17
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Oudaina W, Assini K, El Ouardi M, Tligui H. [Severe macrophage activation syndrome following visceral leishmaniasis in a child]. Med Sante Trop 2014; 24:221-3. [PMID: 24876180 DOI: 10.1684/mst.2014.0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Visceral leishmaniasis (VL) is a parasitic disease that is a public health problem in Morocco and is one of the frequent infectious causes of macrophage activation syndrome (MAS). The combination of clinical and laboratory criteria, even very unspecific, make it possible to diagnose MAS, but a definitive diagnosis requires cytological examination. Rapid treatment is essential. The outcome was favorable.
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Marques IDB, Caires RA, de Paula FJ, Nahas WC, David-Neto E. Rejection-triggered haemophagocytic syndrome in renal transplantation successfully treated with intravenous immunoglobulin. Clin Kidney J 2013; 6:530-2. [PMID: 26064519 PMCID: PMC4438393 DOI: 10.1093/ckj/sft077] [Citation(s) in RCA: 5] [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: 03/08/2013] [Accepted: 06/14/2013] [Indexed: 11/12/2022] Open
Abstract
Haemophagocytic syndrome (HPS) is a rare and potentially lethal condition characterized by pancytopoenia, fever, organomegaly and widespread proliferation of macrophages phagocytosing blood elements. Among the triggers of this syndrome, excessive immunosuppression in a context of acute rejection has been rarely reported, although it might be underdiagnosed. Here, we report the case of a kidney transplant recipient with allograft dysfunction due to chronic antibody-mediated rejection treated with antithymocyte globulin and plasmapheresis. The patient developed high fever, pancytopoenia, diarrhoea and respiratory symptoms with no apparent infectious or neoplastic cause, despite an extensive work-up. Haemophagocytosis was found in bone marrow examination, along with hyperferritinaemia and hypertriglyceridaemia. The clinical profile improved after treatment with intravenous immunoglobulin and reduction of the basal immunosuppression.
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Affiliation(s)
| | - Renato Antunes Caires
- Nephrology Division , Hospital das Clínicas, University of São Paulo School of Medicine , São Paulo , Brazil
| | - Flávio Jota de Paula
- Renal Transplant Service , Hospital das Clínicas, University of São Paulo School of Medicine , São Paulo , Brazil
| | - William Carlos Nahas
- Renal Transplant Service , Hospital das Clínicas, University of São Paulo School of Medicine , São Paulo , Brazil
| | - Elias David-Neto
- Renal Transplant Service , Hospital das Clínicas, University of São Paulo School of Medicine , São Paulo , Brazil
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19
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Giardino G, Veropalumbo C, Ruggiero G, Naddei R, Rubino V, Udhayachandran A, Cirillo E, Gallo V, Poggi V, De Fusco C, Pignata C. Phenotypic characterization and outcome of paediatric patients affected with haemophagocytic syndrome of unknown genetic cause. Br J Haematol 2013; 162:713-7. [PMID: 23808825 DOI: 10.1111/bjh.12421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chen RL, Hsu YH, Ueda I, Imashuku S, Takeuchi K, Tu BPH, Chuang SS. Cytophagic histiocytic panniculitis with fatal haemophagocytic lymphohistiocytosis in a paediatric patient with perforin gene mutation. J Clin Pathol 2007; 60:1168-9. [PMID: 17601962 PMCID: PMC2014859 DOI: 10.1136/jcp.2007.049551] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2007] [Indexed: 11/04/2022]
Affiliation(s)
- Rong-Long Chen
- Division of Paediatric Hematology/Oncology, Cancer Centre, Chi-Mei Medical Centre, Liou Ying Campus, Tainan, Taiwan
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21
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Al Sineidi K, Wali YA, Pathare AV, Al Lamki Z. Visceral leishmaniasis and haemophagocytic syndrome in an Omani child. J Sci Res Med Sci 2002; 4:45-48. [PMID: 24019726 PMCID: PMC3174714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The paper reports the case of a previously healthy 4-year-old-girl who presented with pallor, fever and hepatosplenomegaly. Laboratory findings included pancytopenia, hypertriglyceridemia and hyperferritinemia. Initial diagnosis of kala-azar could not be confirmed because of the absence of clinical evidence, negativity of bone marrow aspiration or specific serology for visceral leishmaniasis. Repeated marrow aspiration, performed due lack of clinical response, revealed histiocytes showing haemophagocytosis consistent with haemophagocytic lymphohistocytosis (HLH) and appropriate treatment was started. She continued to have high-grade fever, and a third bone marrow aspiration ultimately revealed presence of Leishmania amastigotes with evidence of active haemophagocytosis. The girl was treated with liposomal amphotericin (AmBisome) for 5 days, following which she recovered rapidly with definitive remission.
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Affiliation(s)
- Khalfan Al Sineidi
- Department of Child Health (Haematology/Oncology Unit), College of Medicine & Health Sciences, Sultan Qaboos University, P.O.Box: 35, Al Khod-123, Sultanate of Oman
| | - Yasser A. Wali
- Department of Child Health (Haematology/Oncology Unit), College of Medicine & Health Sciences, Sultan Qaboos University, P.O.Box: 35, Al Khod-123, Sultanate of Oman
| | - Anil V. Pathare
- Department of Haematology, Sultan Qaboos University Hospital, P.O.Box: 38, Al Khod-123, Sultanate of Oman
| | - Zakia Al Lamki
- Department of Child Health (Haematology/Oncology Unit), College of Medicine & Health Sciences, Sultan Qaboos University, P.O.Box: 35, Al Khod-123, Sultanate of Oman
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Benveniste O, Dereuddre-Bosquet N, Clayette P, Leport C, Vildé JL, Dormont D. High levels of IL-10 and determination of other cytokines and chemokines in HIV-associated haemophagocytic syndrome. Clin Exp Immunol 2000; 121:320-3. [PMID: 10931148 PMCID: PMC1905689 DOI: 10.1046/j.1365-2249.2000.01288.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Haemophagocytic syndrome (HPS) and HIV infection are both associated with cytokine network dysregulation. We therefore analysed plasma levels and mRNA synthesis in peripheral blood mononuclear cells (PBMC) of cytokines, chemokines and chemokine receptors in one HIV-infected patient with HPS. We compared the results with those for eight HIV-infected patients with similar CD4+ T cell counts (207/mm3 versus controls: median 214/mm3) and plasma virus load (4.1 log copies/ml, versus controls: median 4.2 log copies/ml). The HPS patient had a lower viral DNA load in PBMC and higher plasma levels of interferon-gamma, IL-10, and macrophage inflammatory protein (MIP)-1beta. No difference in plasma tumour necrosis factor-alpha (TNF-alpha), IL-6 and MIP-1alpha concentration was observed between the HPS patient and control patients. No difference was observed in TNF-alpha, IL-1beta, IL-10, IL-4, MIP-1alpha, MIP-1beta, RANTES, CXCR-4, and CCR-5 mRNA levels in PBMC, but IL-6 levels were higher in the HPS patient. Our results emphasize the role of IL-10 in the control of immune hyperactivation that is observed in HPS.
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Affiliation(s)
- O Benveniste
- CEA, Service de Neurovirologie, CRSSA, DRM/DSV, Institut Paris-Sud sur les Cytokines, B.P. 6, Fontenay aux Roses Cedex, France.
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