Buleza Nicole, Amanat Ammaar, Terrigno Nicole
Internal Medicine, Inspira Health Network, Mullica Hill, USA.
Internal Medicine, Cooper University Hospital, Camden, USA.
Cureus. 2025 Apr 21;17(4):e82733. doi: 10.7759/cureus.82733. eCollection 2025 Apr.
Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening syndrome of excessive immune activation triggered by infections, malignancy, or genetic abnormalities. While the Epstein-Barr virus (EBV) is commonly associated with HLH, COVID-19 still lacks a well-defined association with this syndrome. This case describes a woman with a recent COVID-19 infection with the presumed reactivation of EBV, leading to fatality secondary to HLH. Initial suspicion was high for acute cholecystitis. However, multiple repeat imaging was negative, and the patient's rapid decline and constellation of laboratory results and symptoms are highly suggestive of a secondary HLH due to EBV reactivation. Re-elevation of EBV viral capsid antigen immunoglobulin G (IgG) antibody can be an indicator of EBV reactivation, and COVID-19 patients with EBV reactivation appear to have an increased risk of death. This case represents a novel presentation of secondary HLH. Further studies are needed to establish the role of antiviral therapies, such as ganciclovir, in treatment as well as to evaluate the prognostic value of early antiviral administration in COVID-19-reactivated herpesvirus infections, such as EBV. However, whether antiviral therapy may decrease mortality in HLH triggered by COVID-19-reactivated EBV infections warrants further investigation.
噬血细胞性淋巴组织细胞增生症（HLH）是一种由感染、恶性肿瘤或基因异常引发的罕见且危及生命的过度免疫激活综合征。虽然EB病毒（EBV）通常与HLH相关，但新型冠状病毒肺炎（COVID-19）与该综合征的关联仍不明确。本病例描述了一名近期感染COVID-19的女性，推测EBV重新激活，导致继发HLH死亡。最初高度怀疑为急性胆囊炎。然而，多次重复影像学检查均为阴性，患者病情迅速恶化以及一系列实验室检查结果和症状高度提示因EBV重新激活导致继发性HLH。EB病毒衣壳抗原免疫球蛋白G（IgG）抗体再次升高可能是EBV重新激活的一个指标，且EBV重新激活的COVID-19患者似乎死亡风险增加。本病例代表了继发性HLH的一种新表现形式。需要进一步研究以确定抗病毒治疗（如更昔洛韦）在治疗中的作用，以及评估早期抗病毒治疗对COVID-19重新激活的疱疹病毒感染（如EBV）的预后价值。然而，抗病毒治疗是否可降低由COVID-19重新激活的EBV感染引发的HLH的死亡率，仍有待进一步研究。
