Secondary Hemophagocytic Lymphohistiocytosis in Post-COVID-19 Patients: A Report of Two Cases.

Pranjal Kalita,Jaya Mishra,Biswajit Dey,Himesh Barman,Bhupen Barman,Devina Laishram

doi:10.7759/cureus.17328

Abstract

Hemophagocytic lymphohistiocytosis (HLH) is a disease that can affect both children and adults. HLH can be categorized as primary or secondary. Secondary HLH (sHLH) may be secondary to various viral infections. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus infection is a pandemic with multi-system involvement. HLH in COVID-19 positive patients is a recognized entity. However, in post-COVID-19 patients who have recovered and are negative by serological tests and reverse transcription-polymerase chain reaction test may present with sHLH due to dysregulation of the immune system. We highlight this unusual finding of post-COVID-19 sHLH in two cases, who were diagnosed by the new revised H-score.

Highlights

Hemophagocytic lymphohistiocytosis (HLH) is a lethal disorder of varying etiology and encompasses a wide range of diseases
We report two cases of post-COVID-19 patients presenting with Secondary HLH (sHLH)
HLH is characterized by a “cytokine storm” caused by uncontrolled activation of cytotoxic T-lymphocytes, and natural killer (NK) cells leading to increased secretion of IFN-γ, TNF-α, and IL-1ß,2,6,12,16 which turns macrophage hyperactive [4]

Summary

Introduction

Hemophagocytic lymphohistiocytosis (HLH) is a lethal disorder of varying etiology and encompasses a wide range of diseases. We report two cases of post-COVID-19 patients presenting with sHLH. How to cite this article Kalita P, Laishram D, Dey B, et al (August 20, 2021) Secondary Hemophagocytic Lymphohistiocytosis in Post-COVID-19 Patients: A Report of Two Cases. The patient responded to treatment without the addition of etoposide and was hemodynamically stable She was discharged after four weeks of hospital stay. The patient was positive for SARS-CoV-2 virus by RT-PCR and was admitted to COVID-19 designated hospital. He was discharged after testing negative for the SARS-CoV-2 virus. After two weeks of discharge, he presented with the above symptoms but was negative for COVID-19 by RAT and RT-PCR. The patient was being monitored in PICU at the time of submission of the manuscript

Discussion

Conclusions

Disclosures

George MR