Naous Elie, Nassani Bertha-Maria, Yaghi Cesar, Nasr Fadi, Medlej Rita
Department of Internal Medicine, Endocrinology Division, Hotel Dieu de France Hospital, Beirut, Lebanon.
Saint Joseph University, Beirut, Lebanon.
J Hematop. 2021 Apr 20;14(3):229-233. doi: 10.1007/s12308-021-00452-w. eCollection 2021 Sep.
'Post-acute coronavirus disease 2019 (COVID-19) syndrome' is a new term that was coined to describe a constellation of persistent symptoms and new complications following recovery from COVID-19 initial illness. Identifying post-COVID-19 complications is crucial for early diagnosis and subsequent initiation of therapies to ensure more favorable outcomes. Severe COVID-19-related hemophagocytic lymphohistiocytosis (HLH) has been previously described during the acute phase of the infection. It is characterized by hyperinflammation, multi-organ involvement, and hemophagocytosis. We report the case of a 69-year-old woman who presented, two weeks after recovery from COVID-19, with hyperosmolar state and high inflammatory markers. Bone marrow aspirate, flow cytometry, extensive viral panel and total body scan were performed. Review of bone marrow aspirate smear showed hemophagocytosis. Flow cytometry, viral panel, and total body scan were normal. The diagnosis of post COVID-19-related HLH was made. Unfortunately, the patient died despite adequate treatment. To our knowledge, this is the first case establishing a high probability of COVID-19-related HLH given its occurrence two weeks following a documented biological and clinical recovery. Awareness and early recognition of HLH features following COVID-19 recovery should prompt timely initiation of therapy.
“新型冠状病毒肺炎（COVID-19）后综合征”是一个新术语，用于描述COVID-19初发疾病康复后出现的一系列持续症状和新并发症。识别COVID-19后并发症对于早期诊断及随后启动治疗以确保更有利的结果至关重要。此前曾报道过在感染急性期出现的严重COVID-19相关噬血细胞性淋巴组织细胞增生症（HLH）。其特征为炎症反应过度、多器官受累及噬血细胞现象。我们报告了一例69岁女性病例，该患者在COVID-19康复两周后出现高渗状态及高炎症标志物。进行了骨髓穿刺、流式细胞术、广泛病毒检测及全身扫描。骨髓穿刺涂片检查显示有噬血细胞现象。流式细胞术、病毒检测及全身扫描均正常。确诊为COVID-19相关HLH。不幸的是，尽管给予了充分治疗，患者仍死亡。据我们所知，鉴于该病例在有记录的生物学和临床康复两周后发生，这是首例高度疑似COVID-19相关HLH的病例。对COVID-19康复后HLH特征的认识和早期识别应促使及时启动治疗。
