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SECONDARY HEMOPHAGOCYTIC LYMPHOHISTIOCYTIC SYNDROME IN SEVERE COVID-19 INFECTION: DIAGNOSTIC CHALLENGES AND A CASE DISCUSSION

Volume 7, Issue 1, February 2022    |    PP. 16-29    |PDF (805 K)|    Pub. Date: January 10, 2022
DOI: 10.54647/cm32748    12 Downloads     136 Views  

Author(s)
SAMIA HASSAN RIZK, PROFESSOR OF CLINICAL PATHOLOGY, FACULTY OF MEDICINE, CAIRO UNIVERSITY

Abstract
The hemophagocytic lymphohistiocytic syndrome (HLH) has been reported in critically ill patients with confirmed sars-cov-2 infection and contributes to their morbidity and mortality. Precise criteria for diagnosis and monitoring of HLH in these patients are essential for improving their clinical outcomes. The diagnosis of HLH depends on several clinical, laboratory, and morphologic parameters according to the HLH-2004 guidelines and its update for adult patients. Recently, the H-score tool provides a quantitative score that can be used to monitor clinical severity and detect early cases with incomplete criteria. Other differential diagnoses which should be considered in COVID-19 infection associated with 2ry HLH are sepsis and septic shock, and cytokine release syndrome (CRS) due to a wide overlap of clinicopathologic findings. The pathogenesis of COVID-19 associated 2ry HLH and whether a direct causal relationship exists between them are areas of intense investigation. A case of 65 years male with a documented COVID-19 disease and an associated 2ry HLH, 1 month following infection is reported, using both the HLH-2004 guidelines and a high H-score (>169). We recommend the use of a wide laboratory diagnostic panel for precise confirmation of HLH in all patients with early signs of clinical deterioration or underlying morbidity. These patients should be regularly monitored according to their rate of decline to allow for early intervention.

Keywords
COVID-19, HEMOPHAGOCYTOSIS, HLH, BONE MARROW MACROPHAGE, H-SCORE, PATHOGENESIS

Cite this paper
SAMIA HASSAN RIZK, SECONDARY HEMOPHAGOCYTIC LYMPHOHISTIOCYTIC SYNDROME IN SEVERE COVID-19 INFECTION: DIAGNOSTIC CHALLENGES AND A CASE DISCUSSION, SCIREA Journal of Clinical Medicine. Vol. 7 , No. 1 , 2022 , pp. 16 - 29 . https://doi.org/10.54647/cm32748

References

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