1.Acute Human Immunodeficiency Virus Syndrome Presenting with Hemophagocytic Lymphohistiocytosis.
Kyung Hwa PARK ; Ho Sung YU ; Sook In JUNG ; Dong Hyeon SHIN ; Jong Hee SHIN
Yonsei Medical Journal 2008;49(2):325-328
Hemophagocytic lymphohistiocytosis (HLH) has been described in patients with advanced stages of human immunodeficiency virus (HIV) infection, but rarely occurs during the seroconversion stage of acute HIV infection. We report a case of acute HIV syndrome that presented with virus-associated HLH. The patient recovered spontaneously without any immunomodulating therapy. This case suggests that acute HIV infection should be included in the differential diagnosis of HLH and indicates that HLH associated with acute HIV infection can have a favorable outcome.
Acquired Immunodeficiency Syndrome/complications/*diagnosis
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Adult
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Diagnosis, Differential
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HIV Infections/complications/*diagnosis
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Humans
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Korea
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Lymphohistiocytosis, Hemophagocytic/etiology/*pathology
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Male
2.Hemophagocytic lymphohistiocytosis caused by hematogenous disseminated pulmonary tuberculosis: A case report.
Qiu Yu LI ; Ying LIANG ; Ni Ni DAI ; Yu Xiang WANG ; Bo Tao ZHU ; Rui WU ; Hong ZHU ; Yong Chang SUN
Journal of Peking University(Health Sciences) 2022;54(6):1219-1223
Hemophagocytic lymphohistiocytosis (HLH) was a life-threatening syndrome due to the uncontrolled immune activation of cytotoxic T lymphocytes, natural killer (NK) cells, and macrophages. HLH is characterized by primary and secondary causes, the early diagnosis and treatment of patients are closely related to the prognosis and clinical outcome of patients. The clinical presentation is variable but mostly includes prolonged fever, splenomegaly, coagulopathy, hypertriglyceridemia, and hemophagocytosis, none of them is specific and particular for HLH. Tuberculosis (TB) infection is one of the causes of HLH. HLH caused by TB is very rare clinically, but it has a high mortality. For patients with fever of unknown origin, HLH-related clinical manifestations sometimes present before the final diagnosis of TB, and HLH is associated with the most significant mortality rate. This article is mainly about a 28-year-old patient with HLH who suffered from severe TB infection. The patient attended a hospital with a history of 2 months of prolonged fever, 10 days booger and subcutaneous hemorrhage in lower limbs. Before this, he was in good health and denied any history of tuberculosis exposure. Combined with relevant laboratory test results (such as splenomegaly, hemoglobin, platelet count, and hypertriglyceridemia) and clinical manifestations (e.g. fever), the patient was diagnosed with hemophagocytic lymphohistiocytosis, but the etiology of HLH remained to be determined. To confirm the etiology, the patient was asked about the relevant medical history (intermittent low back pain) and was performed chest CT scan, bone marrow biopsy, and fundus photography. Finally, he was diagnosed with hemophagocytic lymphohistiocytosis caused by hematogenous disseminated pulmonary tuberculosis. In response to this, intravenous methylprednisolone and anti-tuberculosis treatment (isoniazid, pyrazinamide, moxifloxacin, and amikacin) were administered to the patient. After more than a month of treatment, the patient recovered from HLH caused by severe TB infection. Therefore, this case suggests that we should be vigilant to the patient who admitted to the hospital with fever for unknown reasons, to diagnose HLH as early as possible and clarify its cause, then perform interventions and treatment, especially HLH secondary to tuberculosis. Also, cases of atypical TB and severe TB should be carefully monitored to achieve early diagnosis and early intervention.
Male
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Humans
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Adult
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Lymphohistiocytosis, Hemophagocytic/diagnosis*
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Splenomegaly
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Tuberculosis, Pulmonary/diagnosis*
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Bone Marrow/pathology*
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Fever/etiology*
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Hypertriglyceridemia/complications*
3.A Case of Hemophagocytic Syndrome with Terminal Ileal Ulcerations.
Jae Hyun MOON ; Sung Pyo HONG ; Pil Won PARK ; Kwang Hyun KO ; Seong Gyu HWANG ; Kyu Sung RIM ; Hee Jung AN ; Myung Seo KANG
The Korean Journal of Gastroenterology 2006;48(3):205-209
Reactive hemophagocytic syndrome or hemophagocytic lymphohistiocytosis, is characterized by the proliferation of benign histiocytes showing phagocytosis of blood cells in hematopoietic organs including bone marrow, spleen, or lymph nodes, accompanied by fever, hepatosplenomegaly, hepatic dysfunction, pancytopenia, and hypertriglyceridemia. The pathogenesis of reactive hemophagocytic syndrome is unknown. It is often associated with infection, malignant neoplasm, autoimmune disease, drugs and various immunodeficiencies. The prognosis of this syndrome is poor and the causes of death are hemorrhage, infection, or multiorgan failure. We experienced a case of hemophagocytic syndrome with terminal ileal ulcers, not associated with other causes. Thus, we report this case with a review of literatures.
Adult
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Fatal Outcome
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Humans
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Ileal Diseases/complications/*diagnosis
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Lymphohistiocytosis, Hemophagocytic/complications/*diagnosis/pathology
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Male
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Tomography, X-Ray Computed
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Ulcer/complications/*diagnosis
4.A Case of Therapy-Related Acute Monocytic Leukemia following Low-dose of Etoposide Treatment for Hemophagocytic Lymphohistiocytosis.
Young Ik SEO ; Rojin PARK ; Tae Youn CHOI ; Jeung Won SHIN ; Jong Ho WON ; Hee Sook PARK ; Nam Soo LEE ; Duck CHO
The Korean Journal of Laboratory Medicine 2007;27(4):244-247
We report a case of therapy-related acute myeloid leukemia after low-dosed topoisomerase II inhibitor (etoposide) treatment for hemophagocytic lymphohistiocytosis (HLH). A 62-yr-old female patient had previously been treated with a HLH-94 protocol containing a low-dose of etoposide (total dose of 300 mg/m2). Thirty-one months later, the patient was admitted to the hematology department with general weakness and upper respiratory infection symptoms. Peripheral blood smear and bone marrow study revealed acute monocytic leukemia. There was no evidence of myelodysplastic syndrome, and a cytogenetic study showed no chromosomal abnormalities.
Bone Marrow/pathology
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Etoposide/administration & dosage/*adverse effects
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Female
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Humans
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Leukemia, Monocytic, Acute/*chemically induced/*diagnosis/therapy
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Lymphohistiocytosis, Hemophagocytic/complications/*drug therapy
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Middle Aged
5.MR Findings of Fulminent Leukoencephalopathy in EBV-Associated Hemophagocytic Syndrome.
Jinna KIM ; Seung Koo LEE ; Seung Ho JOO ; Dong Ik KIM ; Heung Dong KIM
Yonsei Medical Journal 2006;47(6):873-876
Various manifestations of brain involvement for patients with virus-associated hemophagocytic syndrome have been reported. Here, we report on the sequential magnetic resonance (MR) findings of acute demyelination of the entire brain with subsequent brain atrophy in a follow-up study of a 25-month- old boy who was admitted with fever and then diagnosed with infectious mononucleosis and EBV-associated hemophagocytic syndrome. We also review other conditions that should be included in the differential diagnosis of this disease.
Male
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*Magnetic Resonance Imaging
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Lymphohistiocytosis, Hemophagocytic/etiology/*pathology/virology
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Humans
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Epstein-Barr Virus Infections/complications/*pathology
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Diagnosis, Differential
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Demyelinating Diseases/complications/*pathology/virology
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Child, Preschool
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Brain Diseases/complications/*pathology/virology
6.MR Findings of Fulminent Leukoencephalopathy in EBV-Associated Hemophagocytic Syndrome.
Jinna KIM ; Seung Koo LEE ; Seung Ho JOO ; Dong Ik KIM ; Heung Dong KIM
Yonsei Medical Journal 2006;47(6):873-876
Various manifestations of brain involvement for patients with virus-associated hemophagocytic syndrome have been reported. Here, we report on the sequential magnetic resonance (MR) findings of acute demyelination of the entire brain with subsequent brain atrophy in a follow-up study of a 25-month- old boy who was admitted with fever and then diagnosed with infectious mononucleosis and EBV-associated hemophagocytic syndrome. We also review other conditions that should be included in the differential diagnosis of this disease.
Male
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*Magnetic Resonance Imaging
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Lymphohistiocytosis, Hemophagocytic/etiology/*pathology/virology
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Humans
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Epstein-Barr Virus Infections/complications/*pathology
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Diagnosis, Differential
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Demyelinating Diseases/complications/*pathology/virology
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Child, Preschool
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Brain Diseases/complications/*pathology/virology
7.Hemophagocytic Syndrome in a Patient with Acute Tubulointerstitial Nephritis Secondary to Hepatitis A Virus Infection.
Eunjung CHO ; Inhye CHA ; Kichul YOON ; Ha Na YANG ; Hye Won KIM ; Myung Gyu KIM ; Sang Kyung JO ; Won Yong CHO ; Hyoung Kyu KIM
Journal of Korean Medical Science 2010;25(10):1529-1531
Hepatitis A virus (HAV) infection is generally a self-limited disease, but the infection in adults can be serious, to be often complicated by acute kidney injury (AKI) and rarely by virus-associated hemophagocytic syndrome (VAHS). Our patient, a 48-yr-old man, was diagnosed with HAV infection complicated by dialysis-dependent AKI. His kidney biopsy showed acute tubulointerstitial nephritis with massive infiltration of activated macrophages and T cells, and he progressively demonstrated features of VAHS. With hemodialysis and steroid treatment, he was successfully recovered.
Acute Disease
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Acute Kidney Injury/diagnosis/therapy
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Antibodies, Viral/analysis
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Hepatitis A/complications/*diagnosis/immunology
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Humans
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Lymphohistiocytosis, Hemophagocytic/complications/*diagnosis/pathology
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Macrophages/immunology
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Male
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Middle Aged
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Nephritis, Interstitial/complications/*diagnosis
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Renal Dialysis
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T-Lymphocytes/immunology
8.Kaposi Sarcoma Herpes Virus-associated Hemophagocytic Syndrome Complicated by Multicentric Castleman Disease and Kaposi Sarcoma in a HIV-negative Immunocompetent Patient: An Autopsy Case.
Bomi KIM ; Yoon Kyung JEON ; Chul Woo KIM
Journal of Korean Medical Science 2009;24(5):970-974
Kaposi sarcoma herpes virus (KSHV), also known as human herpesvirus-8, plays an important role in the pathogenesis of Kaposi sarcoma (KS), multicentric Castleman disease (MCD) of the plasma cell type, and primary effusion lymphoma. KSHV is rarely associated with the hemophagocytic syndrome (HPS), but when it does occur, it most occurs in immunocompromised patients. We report herein an unusual case of KSHV-associated HPS in an immunocompetent patient. A previously healthy 62-yr-old male was referred for evaluation of leukocytopenia and multiple lymphadenopathies. After a lymph node biopsy, he was diagnosed with MCD of the plasma cell type. KSHV DNA was detected in the lymph node tissue by polymerase chain reaction. Following a short-term response of the leukocytopenia to prednisolone, mental change, left side weakness, fever, thrombocytopenia, hemolytic anemia, and renal failure developed. Despite intravenous immunoglobulin therapy and plasmapheresis, he expired. The lymph nodes were infiltrated by hemophagocytic histiocytes in the sinuses. Pulmonary nodules and gastric erosions were shown to be KS. KSHV DNA was detected in the stomach, lung, and liver. This is the first case of multiple KSHV associated diseases including MCD and KS with KSHV-associated hemophagocytic syndrome in an HIV-negative, non-transplant, immunocompetent patient.
Autopsy
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Giant Lymph Node Hyperplasia/complications/*diagnosis/pathology
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HIV Seronegativity
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Herpesviridae Infections/*diagnosis
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Herpesvirus 8, Human/*isolation & purification
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Humans
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Immunocompetence
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Lymphohistiocytosis, Hemophagocytic/*diagnosis/etiology
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Magnetic Resonance Imaging
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Male
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Middle Aged
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Polymerase Chain Reaction
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Sarcoma, Kaposi/complications/*diagnosis
9.A Case of Hemophagocytic Syndrome in an Ulcerative Colitis Patient.
Yong Cheol KIM ; Gun Min KIM ; Ho Sang LEE ; Seok In HONG ; Dae Young CHEUNG ; Jin Il KIM ; Soo Heon PARK ; Jae Kwang KIM
The Korean Journal of Gastroenterology 2010;56(1):45-48
A case of hemophagocytic syndrome associated with ulcerative colitis is very rare. A 32-year-old man visited the hospital complaining of fever and severe abdominal pain for 7 days. He was diagnosed to have ulcerative colitis 2 years ago and had been treated with sulfasalazine. Three months ago, he had abdominal pain, weight loss, and hematochezia, so prednisolone and mercaptopurine were added to the treatment. On admission, the physical examination showed splenomegaly. Peripheral blood counts revealed pancytopenia, and bone marrow aspirate smears showed many histiocytes with active hemophagocytosis. There was no evidence of viral and bacterial infections and other neoplasms, which were commonly associated with hemophagocytic syndrome. He was successfully treated with high dose steroid. We report this case along with a review of the related literatures.
6-Mercaptopurine/therapeutic use
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Adult
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Anti-Inflammatory Agents/therapeutic use
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Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
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Bone Marrow Cells/pathology
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Colitis, Ulcerative/complications/*diagnosis/drug therapy
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Colonoscopy
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Dexamethasone/therapeutic use
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Humans
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Immunosuppressive Agents/therapeutic use
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Lymphohistiocytosis, Hemophagocytic/complications/*diagnosis/drug therapy
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Male
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Prednisolone/therapeutic use
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Sulfasalazine/therapeutic use
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Syndrome
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Tomography, X-Ray Computed