Abstract
IntroductionHemophagocytic 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 presentationA 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.ConclusionsInfluenza 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.
Highlights
Hemophagocytic lymphohistiocytosis induced by viral diseases is a well recognized entity
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
Summary
Hemophagocytic lymphohistiocytosis with multi-organ failure syndrome can be induced by the novel H1N1 influenza variant. Consent Written informed consent was obtained from the patient’s next-of-kin for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Author details 1Service de Réanimation Polyvalente, Hôpital Roger Salengro, Rue Emile Laine, CHRU, Lille, France. Authors’ contributions CW analyzed the clinical and biological patient data and partially wrote the paper; AC and AW performed the histological examination and interpretation; MJG participated in patient data interpretation and writing of the manuscript; FF initiated the patient analysis and report, and wrote the final version of the manuscript. All authors read and approved the final manuscript. Competing interests The authors declare that they have no competing interests
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