A case of hemophagocytic lymphohistiocytosis in a hemodialysis patient with coronavirus disease 2019

• Published in: CEN case reports Vol. 12; no. 4; pp. 390 - 396
• Main Authors: Kaneko, Satoru, Inoue, Tsutomu, Tarumoto, Norihito, Haga, Yoshiyuki, Yokota, Kazuhiro, Yamaguchi, Hiroshi, Okada, Hirokazu
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.11.2023
• Subjects: Case Report; Medicine; Medicine & Public Health; Nephrology; Urology; COVID-19; Hemophagocytic lymphohistiocytosis; Hemophagocytic syndrome; HScore
• ISSN: 2192-4449; 2192-4449
• DOI: 10.1007/s13730-023-00776-9

During the treatment of a patient on hemodialysis with severe coronavirus disease 2019 (COVID-19), the patient was weaned from extracorporeal membrane oxygenation, which was used to treat severe COVID-19 pneumonia. However, the patient’s condition worsened after the peak infection phase of COVID-19 because of acute respiratory distress syndrome with suspected hemophagocytic lymphohistiocytosis (HLH). After a bone marrow biopsy confirmed the diagnosis, methylprednisolone pulse therapy, followed by combination therapy (including oral prednisolone and cyclosporine) was immediately administered, and the patient survived. Because HLH can occur a month or more after the onset of COVID-19, even if the viral load is reduced to the point of being undetectable by reverse transcriptase-polymerase chain reaction, it can be considered to correspond to the “post-acute COVID-19 syndrome,” which has recently been proposed. Early intervention is necessary, because HLH can be fatal. Therefore, it is important to know that HLH can occur at any stage of COVID-19 and to pay attention to the patient’s progress over time, including checking the HScore.