Hospital General "Dr. Agustín O'Horán", División de Pediatría, Mérida, Yucatán, México.
Universidad Autónoma de Yucatán, Facultad de Medicina, Unidad Interinstitucional de Investigación Clínica y Epidemiológica, Mérida, Yucatán, México.
Rev Inst Med Trop Sao Paulo. 2020 Dec 18;62:e99. doi: 10.1590/S1678-9946202062099. eCollection 2020.
Hemophagocytic lymphohistiocytosis is a rare complication in Rickettsia typhi infections. We report the case of a 2-year-old boy with sudden night-onset fever, pallor, neck adenopathy and erythematous macular rash on the thorax, thighs and buttocks. During admission, he developed hyponatremia, hypoalbuminemia, anemia, thrombocytopenia, leukopenia, neutropenia, liver damage, hemorrhages and persistent fever. No hematological improvement was observed after the initial management, neoplastic diseases were discarded by bone marrow aspiration and lymph node biopsy; hemophagocytic lymphohistiocytosis was diagnosed. By immunohistochemistry and indirect immunofluorescence, murine typhus was also diagnosed and doxycycline was started with transitory recovery. Later, the child developed kidney failure and distributive shock that evolved to cardiac arrest and death. This is the first case report in Mexico on a fatal murine typhus associated with hemophagocytic lymphohistiocytosis in which the etiology was evidenced by histopathology.
噬血细胞性淋巴组织细胞增生症是伤寒立克次体感染的罕见并发症。我们报告了一例 2 岁男孩的病例，其突然出现夜间发热、苍白、颈部淋巴结肿大和胸部、大腿和臀部出现红斑性斑丘疹。住院期间，他出现低钠血症、低白蛋白血症、贫血、血小板减少、白细胞减少、中性粒细胞减少、肝损伤、出血和持续发热。初始治疗后未观察到血液学改善，骨髓抽吸和淋巴结活检排除了恶性肿瘤疾病；噬血细胞性淋巴组织细胞增生症被诊断。通过免疫组织化学和间接免疫荧光，也诊断了鼠型斑疹伤寒，并用多西环素治疗，病情有短暂好转。后来，患儿出现肾衰竭和分布性休克，继而发展为心脏骤停并死亡。这是墨西哥首例有组织病理学证据的致命性鼠型斑疹伤寒相关噬血细胞性淋巴组织细胞增生症病例报告。
