von der Thüsen Jan H, van Bommel Jasper, Kros Johan M, Verdijk Robert M, Lopuhaä Boaz, Lam King H, Dik Willem A, Miedema Jelle R
Department of Pathology, Erasmus MC, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands.
J Hematop. 2020 Oct 23;14(1):79-83. doi: 10.1007/s12308-020-00423-7. eCollection 2021 Mar.
The clinical features of COVID-19 have a considerable range from a mild illness to severe disease. Underlying pathophysiological mechanisms of the rapidly progressive, and often fatal, pulmonary disease frequently observed in COVID-19 need to be elucidated, in order to develop new treatment strategies for different disease endotypes. Fatal cases can display features of a cytokine storm, which may be related to hemophagocytic lymphohistiocytosis. Also, a spectrum of vascular changes, including microvascular damage, is known to accompany severe COVID-19. In this paper, we describe the co-occurrence of hemophagocytic lymphohistiocytosis and extensive pulmonary microvascular damage with thrombosis and its sequelae in a patient with fatal COVID-19. We believe these response patterns may be linked by common mechanisms involving hypercytokinemia and require further investigation as a fatal constellation in COVID-19, to generate appropriate treatment in patients who display these combined features.
新冠病毒病（COVID-19）的临床特征范围广泛，从轻症到重症不等。为了针对不同疾病亚型制定新的治疗策略，需要阐明COVID-19中经常观察到的快速进展且往往致命的肺部疾病的潜在病理生理机制。致命病例可表现出细胞因子风暴的特征，这可能与噬血细胞性淋巴组织细胞增生症有关。此外，已知包括微血管损伤在内的一系列血管变化与重症COVID-19相伴出现。在本文中，我们描述了一名死于COVID-19的患者同时出现噬血细胞性淋巴组织细胞增生症和广泛的肺微血管损伤伴血栓形成及其后遗症。我们认为，这些反应模式可能通过涉及高细胞因子血症的共同机制联系在一起，作为COVID-19中的一种致命组合需要进一步研究以对表现出这些联合特征的患者进行适当治疗。
