Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne and Duesseldorf, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.
Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases, University of Cologne, Cologne, Germany.
Infection. 2022 Oct;50(5):1399-1404. doi: 10.1007/s15010-022-01786-y. Epub 2022 Feb 26.
The coronavirus disease 2019 (COVID-19) pandemic has led to the approval of novel vaccines with different mechanisms of action. Until now, more than 4.7 billion persons have been vaccinated around the world, and adverse effects not observed in pre-authorization trials are being reported at low frequency.
We report a case of severe hemophagocytic lymphohistiocytosis (HLH) after SARS-CoV-2 immunization and performed a literature search for all reported cases of COVID-19 vaccine-associated HLH.
A 24-year-old female developed HLH after immunization with the mRNA COVID-19 vaccine Comirnaty. Diagnosis was made according to HLH-2004 criteria; the HScore was 259 (> 99% HLH probability) with maximum ferritin of 138.244 µg/L. The patient was initially treated with intravenous immunoglobulins (IVIGs) and dexamethasone without response. The addition of the human interleukin 1 receptor antagonist Anakinra resulted in full recovery within 6 weeks after vaccination. A literature search revealed 15 additional cases of HLH after SARS-CoV-2 vaccination, the majority after immunization with Comirnaty (n = 7) or the viral vector vaccine Vaxzevria (n = 6). Treatment modalities included corticosteroids (n = 13), Anakinra (n = 5), IVIGs (n = 5), and etoposide (n = 2). Eight patients underwent combination treatment. Three of 16 patients died.
COVID-19 vaccines may occasionally trigger HLH, and Anakinra may be an efficacious treatment option for this condition.
2019 年冠状病毒病（COVID-19）大流行导致了具有不同作用机制的新型疫苗获得批准。截至目前，全球已有超过 47 亿人接种了疫苗，并且在授权前试验中未观察到的不良反应以低频率报告。
我们报告了一例接种 SARS-CoV-2 疫苗后发生严重噬血细胞性淋巴组织细胞增生症（HLH）的病例，并对所有报告的 COVID-19 疫苗相关 HLH 病例进行了文献检索。
一名 24 岁女性在接种 mRNA COVID-19 疫苗 Comirnaty 后发生 HLH。根据 HLH-2004 标准诊断；H 评分为 259（>99% HLH 概率），最大铁蛋白为 138244 µg/L。患者最初接受静脉注射免疫球蛋白（IVIGs）和地塞米松治疗，但无反应。加用人白细胞介素 1 受体拮抗剂 Anakinra 后，接种疫苗后 6 周内完全恢复。文献检索显示，15 例 COVID-19 疫苗接种后发生 HLH，其中大多数发生在接种 Comirnaty（n=7）或病毒载体疫苗 Vaxzevria（n=6）后。治疗方式包括皮质类固醇（n=13）、Anakinra（n=5）、IVIGs（n=5）和依托泊苷（n=2）。16 例患者中有 8 例接受联合治疗。16 例患者中有 3 例死亡。
COVID-19 疫苗偶尔会引发 HLH，Anakinra 可能是治疗这种疾病的有效选择。
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