Hemophagocytic syndrome: a potential COVID-19 complication - Respiratory Research & Clinical Practice
Images in Pneumology
, , , , Jornal Brasileiro de Pneumologia. 2020;46(5):e20200296
DOI: 10.36416/1806-3756/e20200296
Publication date: 09-21-2020
A 62-year-old male smoker who was an alcoholic and had diabetes was being treated for mediastinitis after surgical myocardial revascularization when he presented with worsening of the respiratory pattern despite overall improvement, requiring endotracheal intubation. The patient underwent a CT scan of the chest that showed findings consistent with COVID-19 (A and 1B), which was later confirmed by RT-PCR. Seventeen days after the diagnosis of COVID-19, the patient presented with pancytopenia and increased levels of ferritin and IL-2 receptor. Hemophagocytic syndrome (HPS) was therefore suspected. A myelogram confirmed the diagnosis of HPS. Treatment consisted of i.v. immunoglobulin for two days. Thirteen days after the diagnosis of HPS, the patient experienced decreased oxygen saturation and tachypnea. A new CT scan of the chest showed new cavitating pulmonary lesions, superimposed on the pulmonary findings of COVID-19 (C and 1D). Bronchoscopy revealed grossly necrotic tissue and bronchial infection with Aspergillus fumigatus (E). The patient was started on anidulafungin in an attempt to contain the fungal infection; however, given the severity of his condition, he died three days after treatment initiation.
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A 62-year-old male smoker who was an alcoholic and had diabetes was being treated for mediastinitis after surgical myocardial revascularization when he presented with worsening of the respiratory pattern despite overall improvement, requiring endotracheal intubation. The patient underwent a CT scan of the chest that showed findings consistent with COVID-19 (A and 1B), which was later confirmed by RT-PCR. Seventeen days after the diagnosis of COVID-19, the patient presented with pancytopenia and increased levels of ferritin and IL-2 receptor. Hemophagocytic syndrome (HPS) was therefore suspected. A myelogram confirmed the diagnosis of HPS. Treatment consisted of i.v. immunoglobulin for two days. Thirteen days after the diagnosis of HPS, the patient experienced decreased oxygen saturation and tachypnea. A new CT scan of the chest showed new cavitating pulmonary lesions, superimposed on the pulmonary findings of COVID-19 (C and 1D). Bronchoscopy revealed grossly necrotic tissue and bronchial infection with Aspergillus fumigatus (E). The patient was started on anidulafungin in an attempt to contain the fungal infection; however, given the severity of his condition, he died three days after treatment initiation.
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