virus-associated hemophagocytic syndrome in renal transplant recipients: report of 2 cases from a single center

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ID: 173099
2015
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Ranked #44 of 57 articles by views in Turkish journal of haematology : official journal of Turkish Society of Haematology

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Abstract
Virus-associated hemophagocytic syndrome (HPS) is a potentially fatal complication of immunosuppression for transplantation. However, it presents with heterogeneous clinical symptoms (fever, disturbed consciousness, and hepatosplenomegaly) and laboratory findings (pancytopenia, elevated hepatic enzyme levels, abnormal coagulation, and hyperferritinemia), impeding diagnosis. Case 1: A 39-year-old female developed fever 4 years after ABO-incompatible living-related renal transplantation. Laboratory findings revealed thrombocytopenia, elevated hepatic enzymes, Epstein-Barr virus (EBV) DNA seropositivity, and hyperferritinemia. EBV-associated HPS was confirmed by bone marrow aspiration. Steroid pulse therapy and etoposide were ineffective. Disseminated intravascular coagulation resulted in multiple organ failure, and the patient died 32 days after disease onset. Case 2: A 67-year-old male was admitted with rotavirus enteritis a month after living-unrelated renal transplantation. He developed sudden-onset high fever, disturbance of consciousness, and tachypnea 8 days after admission. Laboratory findings revealed elevated hepatic enzyme levels, hyperkalemia, and hyperferritinemia. Emergency continuous hemodiafiltration ameliorated the fever, and steroid pulse therapy improved abnormal laboratory values. Varicella-zoster virus meningitis was confirmed by spinal tap. Acyclovir improved consciousness, and he was discharged 87 days after admission. Fatal virus-associated HPS may develop in organ transplant patients receiving immunosuppressive therapy. Pathognomonic hyperferritinemia is useful for differential diagnosis.
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nanmoku2015casevirus-associated Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;Koji Nanmoku;Takayuki Yamamoto;Makoto Tsujita;Takahisa Hiramitsu;Norihiko Goto;Akio Katayama;Shunji Narumi;Yoshihiko Watarai;Takaaki Kobayashi;Kazuharu Uchida
Journal Turkish journal of haematology : official journal of Turkish Society of Haematology
Year 2015
DOI
10.1155/2015/876301
URL
http://dx.doi.org/10.1155/2015/876301
Keywords
Diseases of the blood and blood-forming organs

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