A case of arthritis, fever, and hemophagocytic syndrome

VernacularTitle:临床病例评析——关节炎发热噬血细胞综合征
Author: Hongtao YANG ; Jinxia ZHAO ; Zhongqiang YAO ; Xiangyuan LIU ; Minggui LIN ; Zhao WANG
Publication Type:Journal Article
Keywords: Arthritis,rheumatoid; Fever; Lymphohistiocytosis,hemophagocytic; Infection
From: Chinese Journal of Rheumatology 2015;19(5):323-326
CountryChina
Language:Chinese
Abstract: Objective To explore the diagnostic and differential diagnostic points of patients with rheumatoid arthritis (RA) complicated with fever.Methods Full clinical analysis was performed for a 62-year old patient with RA and fever.Results Hemophagocytes were found in bone marrows smear.Significantly increased ferritin level (74 299 ng/ml),decreased hemoglobin (67 g/L) and platelet (33×109/L),decreased fibrinogen,increased serum soluble CD25 (sCD25),positive cytomegalovirus (CMV) DNA,positive CMV-PP65 antigen,were found by laboratory examination.Decreased activity of NK cells was detected by flow cytometry.Positron emission computed tomography (PET-CT) revealed splenomegaly and pulmonary inflammations.The clinical conditions were recovered with the treatment of corticosteroid,VP16,cyclosporine,anti-CMV virus therapy.Ferritin level was significantly decreased and platelet was normal.The patient was diagnosed as hemophagocytic syndrome associated with CMV infection.Conclusion The possibility of hemophagocytic syndrome should be considered in RA patients presented with fever.