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Báo cáo khoa học: "Fulminant hemophagocytic lymphohistiocytosis induced by pandemic A (H1N1) influenza: a case report."

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Fulminant hemophagocytic lymphohistiocytosis induced by pandemic A (H1N1) influenza: a case report. | Willekens et al. Journal of Medical Case Reports 2011 5 280 http www.jmedicalcasereports.eom content 5 1 280 JOURNAL OF MEDICAL CASE REPORTS CASE REPORT Open Access Fulminant hemophagocytic lymphohistiocytosis induced by pandemic A H1N1 influenza a case report 1.2 3 1 3 1 Christophe Willekens 1 Aurélie Cornelius Mary-Jane Guerry Agnès Wacrenier and Franpois Fourrier Abstract Introduction Hemophagocytic lymphohistiocytosis induced by viral diseases is a well recognized entity. Severe forms of H5N1 influenza are known to be associated with symptoms very similar to a reactive hemophagocytic syndrome. We report a case of fulminant lymphohistiocytosis associated with the pandemic A H1N1 variant. Case presentation A 42-year-old Caucasian woman developed a syndrome of fatal hemophagocytic lymphohistiocytosis shortly after H1N1 influenza. Initial symptoms of the viral disease were unusual with acute abdominal involvement. Our patient s course was complicated by diffuse skin rash and ileal ischemia. Our patient died of refractory shock and multi-organ failure. Skin ileum and colon histology was consistent with an acute apoptosis combined with an increased cellular regeneration. Conclusions Influenza may be complicated by severe forms of hemophagocytic lymphohistiocytosis. To ensure early recognition and treatment physicians should be aware of the possible induction of the syndrome by the novel H1N1 variant. The rapid occurrence of a multi-organ involvement with evocative biological features of macrophage activation should alert clinicians. Introduction Virus-associated hemophagocytic lymphohistiocytosis HLH is a well recognized entity 1 . Most cases are related to Epstein-Barr virus EBV cytomegalovirus CMV and herpes virus infections. Influenza-induced macrophage activation syndrome is very rare. It has been described in isolated case reports of immunocompromised or immunocompetent patients suffering from either avian or swine influenza. Consistent with the deregulation of