Hemophagocytic lymphohistiocytosis trigged by COVID-19 infection: Case report and review of the literature

• Published in: Journal of Applied Hematology Vol. 12; no. 4; pp. 227 - 231
• Main Authors: Fatma Hammami, Makram Koubaa, Khaoula Rekik, Hana Chaabouni, Mourad Chaari, Fatma Smaoui, Mounir Ben Jemaa
• Format: Journal Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 01-10-2021
• Subjects: coronavirus-19; hemophagocytic lymphohistiocytosis; immunosuppression
• ISSN: 1658-5127
• DOI: 10.4103/joah.joah_116_21

The outbreak of the novel coronavirus-19 (COVID-19) rapidly grew into a worldwide pandemic. The link between the disease severity and higher levels of inflammatory markers was reported including cases of hemophagocytic lymphohistiocytosis (HLH), a potentially life-threatening disorder. We report herein a case of HLH trigged by COVID-19 infection and we review all reported cases of HLH secondary to COVID-19 among immunocompromised patients by searching PubMed publications till July 2021. A 69-year-old woman with a previous medical history of diabetes mellitus and rheumatoid arthritis treated with oral steroids presented for a 5-day history of fever, persistent cough, anorexia, and dyspnea. The diagnosis of COVID-19 was confirmed. She received empiric antibiotic therapy, oxygen supply, and corticosteroids. On day 17, laboratory investigations revealed bicytopenia with a platelets rate of 31,000/mm3 and an hemoglobin rate of 8.2 g/dL. Hyperferritinemia, hypertriglyceridemia, and hypofibrinogenemia were noted. Bone marrow aspiration and biopsy revealed images of hemophagocytosis. The HScore yielded 200 points, representing 80%–88% probability of HLH. We continued corticosteroids and treatment. The disease evolution was favorable. The diagnosis of HLH secondary to COVID-19 shoud be considered in front of cytopenia, hyperinflammatory state, and a worsening clinical condition. Prompt diagnosis and treatment improve the prognosis.