Department of Anaesthesia, Virgen de la Victoria University Hospital, Malaga, Spain.
ANESTHESIA-CARDIOLOGY DEPARTMENT, Malaga, Spain.
F1000Res. 2023 Feb 7;10:244. doi: 10.12688/f1000research.50782.2. eCollection 2021.
Our case is unique because the differential diagnosis was a challenge. At first, the patient presented with septic shock and multi-organ failure in the context of a suspected lymphoproliferative syndrome. Once the lymphoproliferative process had been ruled out, hemophagocytic syndrome due to COVID-19 infection was suspected, so he is probably one of the few patients with such an exhaustive study that could contribute to our understanding of COVID-19. We followed therapeutic guidelines that differ from the usual, using adrenalin and levosimendan. Corticosteroids helped to modulate the cytokine storm. A 16-year-old adolescent was admitted to the intensive care unit with fever, diarrhea, multiorgan failure and septic shock. He was IgG positive for COVID-19 and IgM negative. Thoraco-abdominal computed tomography demonstrated multiple para-aortic and peri-pancreatic lymphadenopathy and acute respiratory distress syndrome. The first suspected diagnosis was a lymphoproliferative syndrome and bacterial infection. The second possibility was a hemophagocytic syndrome in a patient recovering from COVID-19. He was treated with broad spectrum antibiotics because the differential diagnosis was difficult, and we removed them when the microbiological screening was negative. During the course of the disease he presented with severe biventricular dysfunction, probably due to the cytokine storm, so we used inotropic drugs (adrenaline, levosimendan). Infection with Salmonella species group B was diagnosed later, when the patient was in the Internal Medicine ward, although he was asymptomatic. : The severity of COVID-19 infection ranges from mild to severe, causing serious disease in some people. Although the pathophysiology is not well known, it seems that in some cases an immune storm is triggered, and it is related to more serious and prolonged disease. In our case, heart failure was important, because it could have worsened the prognosis. Fortunately, the response to levosimendan and corticosteroids was adequate and he recovered favorably until discharge.
我们的病例很独特，因为鉴别诊断极具挑战性。起初，患者表现为感染性休克和多器官衰竭，疑似淋巴增生综合征。一旦排除了淋巴增生过程，就怀疑是 COVID-19 感染引起的噬血细胞综合征，因此他可能是少数接受如此详尽研究的患者之一，这有助于我们了解 COVID-19。我们遵循的治疗指南与常规不同，使用肾上腺素和左西孟旦。皮质类固醇有助于调节细胞因子风暴。一名 16 岁青少年因发热、腹泻、多器官衰竭和感染性休克入住重症监护病房。他的 IgG 对 COVID-19 呈阳性，IgM 呈阴性。胸腹部计算机断层扫描显示多个主动脉旁和胰腺旁淋巴结病和急性呼吸窘迫综合征。最初的疑似诊断是淋巴增生综合征和细菌感染。第二种可能是 COVID-19 恢复期患者的噬血细胞综合征。由于鉴别诊断困难，我们使用了广谱抗生素，当微生物筛查阴性时，我们将其去除。在疾病过程中，他出现严重的双心室功能障碍，可能是由于细胞因子风暴，因此我们使用了正性肌力药物（肾上腺素、左西孟旦）。后来在患者入住内科病房时诊断出感染了 B 群沙门氏菌，但他无症状。：COVID-19 感染的严重程度从轻度到重度不等，在某些人中会导致严重疾病。虽然病理生理学尚不清楚，但似乎在某些情况下会引发免疫风暴，并且与更严重和持久的疾病有关。在我们的病例中，心力衰竭很重要，因为它可能会恶化预后。幸运的是，左西孟旦和皮质类固醇的反应足够好，他恢复良好，直至出院。
