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Hemophagocytic Lymphohistiocytosis Secondary to Varicella Zoster with Acute Liver Failure

DOI: 10.4236/oalib.1107367, PP. 1-6

Subject Areas: Hematology, Gastroenterology & Hepatology, Infectious Diseases

Keywords: Hemophagocytic Lymphohistiocytosis, Varicella Zoster, Liver Failure

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Abstract

Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and life threatening syndrome of excessive immune activation. This condition can be inherited or secondary to other diseases. The therapeutic success is directly related to the rapid diagnosis with the patient who have high clinical suspicious index such as febrile illness with cytopenia, liver enzyme derangement, raised serum ferritin and low fibrinogen levels. Infection is a common trigger both in those with a genetic predisposition and in sporadic cases. We report a 31 years old man who presented with diagnosis of severe varicella zoster infection with multiorgan involvement. The laboratory data showed thrombocytopenia, an elevated level of the liver transaminases and coagulopathy. Antiviral therapy along with supportive treatment initiated. However the general condition deteriorated and he eventually required mechanical ventilation with intensive care unit support. He had persistent high spiking temperature, acute liver failure and raised serum ferritin. With the history of steroid contained health supplements ingestion prior to current hospitalization leading to immunosuppressed state, HLH was diagnosed and treatment was directed towards suppressing the overt immune response. Dexamethasone chosen here because it can cross the blood brain barrier and tapered over the eight week induction. He responded well to treatment and discharged home.

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Ramasundram, S. and Kian, C. K. (2021). Hemophagocytic Lymphohistiocytosis Secondary to Varicella Zoster with Acute Liver Failure. Open Access Library Journal, 8, e7367. doi: http://dx.doi.org/10.4236/oalib.1107367.

References

[1]  Henter, J.I., Horne, A., Aricó, M., Egeler, R.M., Filipovich, A.H., Imashuku, S., Ladisch, S., McClain, K., Webb, D., Winiarski, J., et al. (2007) HLH-2004: Diagnostic and Therapeutic Guidelines for Hemophagocytic Lymphohistiocytosis. Pediatric Blood & Cancer, 48, 124-131. https://doi.org/10.1002/pbc.21039
[2]  Henter, J.I., Elinder, G. and Ost, A. (1991) Diagnostic Guidelines for Hemophagocytic Lymphohistiocytosis. Seminars in Oncology, 18, 29-33.
[3]  Schneier, A., Stueck, A.E., Petersen, B., Thung, S.N. and Perumalswami, P. (2016) An Unusual Cause of Acute Liver Failure: Three Cases of Hemophagocytic Lymphohistiocytosis Presenting at a Transplant Center. Seminars in Liver Disease, 36, 99-105. https://doi.org/10.1055/s-0036-1571299
[4]  Lin, S., Li, Y., Long, J., Liu, Q., Yang, F. and He, Y. (2016) Acute Liver Failure Caused by Hemophagocytic Lymphohistiocytosis in Adults: A Case Report and Review of the Literature. Medicine (Baltimore), 95, e5431. https://doi.org/10.1097/MD.0000000000005431
[5]  Lee, W.M. (2003) Acute Liver Failure in the United States. Seminars in Liver Disease, 23, 217-226. https://doi.org/10.1055/s-2003-42641
[6]  Elizabeth, C.B. and Leigh, H. (2018) Acute Liver Failure Due to Disseminated Varicella Zoster Infection. Hindawi, 2018, Article ID: 1269340. https://doi.org/10.1155/2018/1269340
[7]  Whitley, R.J. (1996) Herpesviruses. In Baron, S., Ed., Medical Microbiology, 4th Edition, University of Texas Medical Branch, Galveston. https://www.ncbi.nlm.nih.gov/books/NBK8157/
[8]  Mehta, R.S. and Smith, R.E. (2013) Hemophagocytic Lymphohistiocytosis (HLH): A Review of Literature. Medical Oncology, 30, 740. https://doi.org/10.1007/s12032-013-0740-3
[9]  Favara, B.E. (1996) Histopathology of the Liver in Histiocytosis Syndromes. Pediatric Pathology & Laboratory Medicine, 16, 413-433. https://doi.org/10.3109/15513819609168681
[10]  Lehmberg, K. and Ehl, S. (2013) Diagnostic Evaluation of Patients with Suspected Haemophagocytic Lymphohistiocytosis. British Journal of Haematology, 160, 275-287. https://doi.org/10.1111/bjh.12138
[11]  Lechiche, V., Le, M., Perrigault, P.F. and Reynes, J. (2006) Fulminant Varicella Hepatitis in a Human Immunodeficiency Virus Infected Patient: Case Report and Review of the Literature. Infectious Diseases, 38, 929-931. https://doi.org/10.1080/00365540600561785
[12]  Schneier, A., Stueck, A.E., Petersen, B., et al. (2016) An Unusual Cause of Acute Liver Failure: Three Cases of Hemophagocytic Lymphohistiocytosis Presenting at a Transplant Center. Seminars in Liver Disease, 36, 99-106. https://doi.org/10.1055/s-0036-1571299

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