Session Type: ePosters
Session Title: ePosters
Authors(s): G. Basile (1), F. Lagi (2), L. Graziani (1), M. Massimo (2), P. Parronchi (1), A. Bartoloni (1, 3)
Authors Affiliations(s): (1) Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy, Italy, (2) Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy, Italy, (3) Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy - Florence (Italy), Italy
Background:
We present a case of secondary hemophagocytic lymphohistiocytosis (HLH), presenting as a late severe COVID-19 complication following its recovery.
HLH is a rare syndrome associated with uncontrolled activation of the immune system. While primary HLH is associated with genetically determined impairment of the cytotoxic machinery of T and NK cells, secondary forms (S-HLH) are triggered by malignant, autoimmune or infective diseases, and in particular by viral infections.
Case:A caucasian 67 years old man had been admitted to our centre two weeks after complete recovery of acute respiratory distress syndrome (ARDS) in COVID-19 pneumonia. He presented with severe asthenia, back pain, and high fever (Tc 39.5°C), while he was tapering the corticosteroids previously prescribed (1 mg/kg of methylprednisolone). A spondylodiscitis was confirmed by PET and MRI pathologic findings in dorsal vertebrae (D4 to D5) and blood culture's positivity for Staphylococcus aureus. The patient presented multiorgan failure (acute renal and respiratory failure, myopericarditis), splenomegaly, severe normocytic anaemia, thrombocytopenia, and elevated ferritin values, disorders initially attributed to sepsis, so corticosteroids were discontinued.
After adequate treatment for the staphylococcal infection we observed a partial resolution of the organ failures. A severe asthenia and transfusion dependant anaemia persisted for more than a month after discharge. Immunological exams revealed lymphopenia with functional depletion of NK cell, and bone marrow biopsy showed low cellularity (20%), increased monocyte-macrophage amount and hemophagocytosis. S-HLH was suspected (Hscore 190 - 6 criteria out of 8), and the patient was treated with high dose corticosteroids (1 mg/kg of methylprednisolone) with rapid resolution of symptoms and anaemia.
Discussion:It is widely acknowledged that severe COVID‐19 is associated with a hyperinflammatory state. S-HLH has been proposed as a possible consequence of the cytokine storm caused by the SARS-CoV-2, but its unusual features may be underrecognized.
In this case the lymphocyte exhaustion of SARS-CoV-2 infection could have played a fundamental role in its etiopathogenesis, while the corticosteroid administered during COVID-19 related ARDS may have delayed the HLH onset.
Keyword(s): hemophagocitic lymphohistiocytosis, COVID-19 complications, staphylococcal spondylodiscitisSession Type: ePosters
Session Title: ePosters
Authors(s): G. Basile (1), F. Lagi (2), L. Graziani (1), M. Massimo (2), P. Parronchi (1), A. Bartoloni (1, 3)
Authors Affiliations(s): (1) Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy, Italy, (2) Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy, Italy, (3) Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy - Florence (Italy), Italy
Background:
We present a case of secondary hemophagocytic lymphohistiocytosis (HLH), presenting as a late severe COVID-19 complication following its recovery.
HLH is a rare syndrome associated with uncontrolled activation of the immune system. While primary HLH is associated with genetically determined impairment of the cytotoxic machinery of T and NK cells, secondary forms (S-HLH) are triggered by malignant, autoimmune or infective diseases, and in particular by viral infections.
Case:A caucasian 67 years old man had been admitted to our centre two weeks after complete recovery of acute respiratory distress syndrome (ARDS) in COVID-19 pneumonia. He presented with severe asthenia, back pain, and high fever (Tc 39.5°C), while he was tapering the corticosteroids previously prescribed (1 mg/kg of methylprednisolone). A spondylodiscitis was confirmed by PET and MRI pathologic findings in dorsal vertebrae (D4 to D5) and blood culture's positivity for Staphylococcus aureus. The patient presented multiorgan failure (acute renal and respiratory failure, myopericarditis), splenomegaly, severe normocytic anaemia, thrombocytopenia, and elevated ferritin values, disorders initially attributed to sepsis, so corticosteroids were discontinued.
After adequate treatment for the staphylococcal infection we observed a partial resolution of the organ failures. A severe asthenia and transfusion dependant anaemia persisted for more than a month after discharge. Immunological exams revealed lymphopenia with functional depletion of NK cell, and bone marrow biopsy showed low cellularity (20%), increased monocyte-macrophage amount and hemophagocytosis. S-HLH was suspected (Hscore 190 - 6 criteria out of 8), and the patient was treated with high dose corticosteroids (1 mg/kg of methylprednisolone) with rapid resolution of symptoms and anaemia.
Discussion:It is widely acknowledged that severe COVID‐19 is associated with a hyperinflammatory state. S-HLH has been proposed as a possible consequence of the cytokine storm caused by the SARS-CoV-2, but its unusual features may be underrecognized.
In this case the lymphocyte exhaustion of SARS-CoV-2 infection could have played a fundamental role in its etiopathogenesis, while the corticosteroid administered during COVID-19 related ARDS may have delayed the HLH onset.
Keyword(s): hemophagocitic lymphohistiocytosis, COVID-19 complications, staphylococcal spondylodiscitis