Abstract
Rationale: The immunologic syndrome induced by severe acute coronavirus disease 2019 (COVID-19) is yet not fully understood. Typical patterns of clinical and laboratory features match secondary hemophagocytic lymphohistiocytosis (sHLH). However, the optimal approach to COVID-19 patients testing positive for sHLH is still unclear.
Patient concerns: Three patients with COVID-19 are reviewed. All showed hyperinflammation and cytokine storm, necessitating intensive care treatment including mechanical ventilation.
Diagnosis: Secondary hemophagocytic lymphohistiocytosis due to severe COVID-19; diagnosed via HScore.
Interventions: A treatment regimen of methylprednisolone, pentaglobin, and anakinra was developed and administered.
Outcomes: One patient survived the ICU stay. Two other patients, in whom sHLH was diagnosed too late, deceased.
Lessons: A routine screening of COVID-19 patients for secondary HLH by using the HScore is feasible; especially those patients deteriorating clinically with no sufficient response to shock management might be at particular high risk. A stepwise therapeutic approach comprising corticosteroids, immunoglobulins and anakinra, accompanied by immunoadsorption, may dampen cytokine storm effects, and potentially reduce mortality.
【초록키워드】 COVID-19, Methylprednisolone, coronavirus disease, Cytokine storm, Corticosteroids, mechanical ventilation, ICU, Shock, Immunoglobulin, management, hyperinflammation, secondary hemophagocytic lymphohistiocytosis, patients, HLH, Therapeutic approach, Deceased, COVID-19 patient, high risk, intensive care treatment, one patient, syndrome, treatment regimen, positive, Administered, sHLH, Effects, approach, secondary, reduce mortality, clinically, diagnosed, survived, accompanied, laboratory feature, patients deteriorating, patients with COVID-19, Typical, 【제목키워드】 Case report, approach,