Case Report: Secondary Hemophagocytic Lymphohistiocytosis (sHLH) and Candida auris Fungemia in Post-acute COVID-19 Syndrome: A Clinical Challenge

被引:5
|
作者
Gautam, Sachin [1 ,2 ]
Sharma, Gaurav [1 ,2 ]
Singla, Sumeet [1 ,2 ]
Garg, Sandeep [1 ,2 ]
机构
[1] Maulana Azad Med Coll, Dept Internal Med, New Delhi, India
[2] Associated Lok Nayak Hop, New Delhi, India
关键词
post acute covid-19 syndrome (PACS); secondary hemophagocytic lymphohistiocytosis; Candida auris; macrophage activation syndrome (MAS); intravenous immunoglobulin; cytokine storm syndrome (CSS); multisystem inflammatory syndrome-adults (MIS-A); hyperferritinemia syndrome; DIAGNOSIS; HSCORE;
D O I
10.3389/fmed.2022.835421
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes a disease (COVID-19) with multisystem involvement. The world is now entering a phase of post-COVID-19 manifestations in this pandemic. Secondary hemophagocytic lymphohistiocytosis (sHLH) is a life-threatening hyperinflammatory event triggered by viral infections, including SARS-CoV-2. Both Multisystem Inflammatory Syndrome-Adults (MIS-A) and Cytokine Storm Syndrome (CSS) are considered close differentials of sHLH and add to the spectrum of Post-acute COVID-19 syndrome (PACS). In this report, we presented the case of a middle-aged Asian man who was initially discharged upon recovery from severe COVID-19 infection after 17 days of hospitalization to a private institute and later came to our hospital 13 days post-discharge. Here, he was diagnosed with sHLH, occurring as an extension of CSS, with delayed presentation falling within the spectrum of PACS. The diagnosis of sHLH was made holistically with the HLH-2004 criteria. Our patient initially responded to intravenous immunoglobulin (IVIG) and dexamethasone, later complicated by disseminated Candida auris infection and had a fatal outcome. Though many cases of HLH during active COVID-19 and a few cases post COVID-19 recovery have been reported, based on H-score, which has limitations as a diagnostic tool. We report the first case report of post-COVID-19 sHLH using the HLH-2004 criteria, complicated by disseminated Candidemia, emphasizing that the care of patients with COVID-19 does not conclude at the time of hospital discharge. We highlight the importance of surveillance in the post-COVID phase for early detection of sHLH which may predispose to fatal opportunistic infections (OIs).
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页数:11
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