Nephrology Department, Clínico San Carlos University Hospital, Madrid, Spain.
Department of Clinical Microbiology and Infectious Diseases, Clínico San Carlos University Hospital, Madrid, Spain.
Transpl Infect Dis. 2021 Dec;23(6):e13732. doi: 10.1111/tid.13732. Epub 2021 Oct 6.
Hemophagocytic syndrome (HPS) is an infrequent complication of transplantation caused by an inflammatory response with a benign proliferation of macrophages and defective lytic capability of T lymphocytes and NK cells that can lead to multiorgan failure. Transplant patients are particularly exposed as a result of the increased risk of both infections and malignancies derived from immunosuppressive drugs. There is no consensus for therapy or immunosuppression; mortality is high. We report a case and present a review of all cases of HPS occurring in solid organ transplant recipients. CASE REPORT: We report two cases of infection by Toxoplasma gondii transmitted by the kidney allograft. One of the recipients was seronegative before transplantation and developed disseminated primary toxoplasmosis. An immune reaction compatible with an HPS ensued. Both were treated with Trimethoprim/sulfamethoxazole, immunosuppression was tapered, and after a 2-week period a complete response was obtained.
HPS presents therapeutic challenges in the context of transplantation. If HPS is suspected, the search of a very likely underlying infection should be central to the management.
噬血细胞综合征（HPS）是一种罕见的移植并发症，由炎症反应引起，表现为巨噬细胞良性增生和 T 淋巴细胞及 NK 细胞的溶解能力缺陷，可导致多器官衰竭。由于免疫抑制药物导致感染和恶性肿瘤的风险增加，移植患者特别容易受到影响。目前对于治疗或免疫抑制尚无共识，死亡率很高。我们报告了两例由肾移植传播的弓形虫感染引起的 HPS 病例，并对所有发生在实体器官移植受者中的 HPS 病例进行了回顾。病例报告：我们报告了两例由肾移植传播的弓形虫感染病例。其中一名受者在移植前血清学阴性，发生播散性原发性弓形体病。随后发生了与噬血细胞综合征相符的免疫反应。两者均接受甲氧苄啶/磺胺甲噁唑治疗，免疫抑制药物逐渐减量，2 周后获得完全缓解。结论：HPS 在移植背景下存在治疗挑战。如果怀疑 HPS，应将寻找可能的潜在感染作为治疗的核心。
