Department of Nephrology, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0451, Japan.
Department of Infectious Disease and Infection Control, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0451, Japan.
CEN Case Rep. 2023 Nov;12(4):390-396. doi: 10.1007/s13730-023-00776-9. Epub 2023 Mar 3.
During the treatment of a patient on hemodialysis with severe coronavirus disease 2019 (COVID-19), the patient was weaned from extracorporeal membrane oxygenation, which was used to treat severe COVID-19 pneumonia. However, the patient's condition worsened after the peak infection phase of COVID-19 because of acute respiratory distress syndrome with suspected hemophagocytic lymphohistiocytosis (HLH). After a bone marrow biopsy confirmed the diagnosis, methylprednisolone pulse therapy, followed by combination therapy (including oral prednisolone and cyclosporine) was immediately administered, and the patient survived. Because HLH can occur a month or more after the onset of COVID-19, even if the viral load is reduced to the point of being undetectable by reverse transcriptase-polymerase chain reaction, it can be considered to correspond to the "post-acute COVID-19 syndrome," which has recently been proposed. Early intervention is necessary, because HLH can be fatal. Therefore, it is important to know that HLH can occur at any stage of COVID-19 and to pay attention to the patient's progress over time, including checking the HScore.
在为一名接受血液透析治疗的严重 2019 冠状病毒病（COVID-19）患者进行治疗时，我们为其撤下了体外膜肺氧合（ECMO）设备，该设备曾用于治疗严重 COVID-19 肺炎。然而，在 COVID-19 感染高峰期过后，患者的病情因急性呼吸窘迫综合征伴疑似噬血细胞性淋巴组织细胞增多症（HLH）而恶化。骨髓活检确诊后，我们立即给予了甲泼尼龙脉冲治疗，随后采用联合治疗（包括口服泼尼松龙和环孢素），患者最终存活下来。由于 HLH 可能在 COVID-19 发病后一个月或更长时间出现，即使逆转录酶-聚合酶链反应（RT-PCR）检测不到病毒载量，也可以认为与最近提出的“急性 COVID-19 后综合征”相对应。早期干预是必要的，因为 HLH 可能致命。因此，了解 HLH 可能出现在 COVID-19 的任何阶段非常重要，需要随着时间的推移关注患者的病情进展，包括检查 H 评分。
