Chinese Medical Sciences Journal ›› 2020, Vol. 35 ›› Issue (4): 371-376.doi: 10.24920/003603
• Case Report • Previous Articles Next Articles
Jie Zhao1, Yimeng Yang2, Shuhong Ming2, *()
Received:
2019-05-08
Accepted:
2019-09-06
Published:
2020-12-31
Online:
2020-09-29
Contact:
Shuhong Ming
E-mail:qzf301@sohu.com
Jie Zhao, Yimeng Yang, Shuhong Ming. Pregnancy-Induced Hemophagocytic Lymphohistiocytosis: A Case Report and Literature Review[J].Chinese Medical Sciences Journal, 2020, 35(4): 371-376.
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Table 1
Laboratory test results of the reported patient during disease development"
Laboratory test indexes | Admission (2018-9-26) | Rapid progression (2018-10-16) | Recovery (2018-11-6) | Normal range |
---|---|---|---|---|
White blood cell (×109/L) | 2.6 | 3.9 | 10.0 | 4-10 |
Hemoglobin (g/L) | 91 | 85 | 90 | 110-150 |
Platelet (×109/L) | 169 | 49 | 253 | 100-300 |
C-reaction protein (mg/dL) | 7.1 | 17.1 | 1.4 | <0.8 |
Procalcitonin (ng/mL) | 0.72 | 0.78 | <0.05 | <0.05 |
Sodium (mmol/L) | 129.6 | 131.1 | 137.6 | 135-148 |
Lactate dehydrogenase (U/L) | 663 | 1109 | 189 | 109-245 |
Triglyceride (mmol/L) | 3.8 | 4.5 | 1.8 | <1.7 |
Ferritin (ng/mL) | 4378.8 | 12445.2 | 453.8 | 4.63-204 |
Activity of NK cell (%) | 16.4 | 15.2 | / | >15.11 |
Soluble CD25 (pg/mL) | 5267 | 13170 | 7137 | <64000 |
D-dimer (ng/mL) | 8314 | 52309 | 1927 | <1000 |
Table 2
Cases of HLH during pregnancy reported in the literature"
No. | Reference | Maternal age (years) | Gestation (weeks) | Associated disease | Treatment | Maternal outcome | Fetal outcome |
---|---|---|---|---|---|---|---|
1 | Nakabayashi et al., 1999[ | 30 | 21 | Preeclampsia | Antithrombin | survive | survive |
2 | Chmait et al., 2000[ | 24 | 29 | Necrotizing lymphadenitis, EBV | Ampicillin, acyclovir Betamethasone, IgG | death | survive |
3 | Hanaoka et al., 2007[ | 33 | 21 | B-cell lymphoma | Emergent caesarean section ; R-CHOP chemotherapy | survive | survive |
4 | Teng et al., 2009[ | 28 | 23 | Autoimmune haemolytic anaemia | No response to corticosteroid; caesarean section | survive | death |
5 | Arewa et al., 2011[ | 31 | 21 | HIV | HAART | survive | survive |
6 | Shukla et al., 2013[ | 23 | 10 | NS | No response to prednisolone; spontaneous abortion | survive | death |
7 | Goulding et al., 2014[ | 27 | 23 | HSV-2 | Acyclovir | survive | death |
8 | Mayama et al., 2014[ | 28 | 20 | Parvovirus B19 | Prednisolone | survive | survive |
9 | Klein et al., 2014[ | 39 | 30 | EBV | Corticosteroid, cyclosporine A, etoposide, Rituximab | death | survive |
10 | Tumian et al., 2015[ | 35 | 38 | CMV | Dexamethasone | death | survive |
11 | Giard et al., 2016[ | 35 | 13 | Streptococcal pharyngitis, KF lymphadenitis | No response to corticosteroids; dexamethasone and etoposide; abortion | death | death |
12 | Rousselin et al., 2017[ | 44 | 30 | Raynaud syndrome, thrombocytopenia | Antimicrobial therapy, glucocorticosteroids | survive | survive |
13 | He et al., 2017[ | 27 | 30 | NK/T cells lymphoma | Dexamethasone, rituximab and etoposide | death | survive |
14 | Ikeda et al., 2017[ | 36 | 11 | EBV | Dexamethasone, cyclosporine, Etoposide | survive | survive |
15 | Yildiz et al., 2018[ | 36 | NS | Acute hepatitis, HIV | Metronidazole, ceftriaxone, methylprednisolone, antibiotherapy | survive | survive |
16 | Wang et al., 2018[ | 40 | NS | UNC13D gene mutation | Etoposide, dexamethasone | survive | death |
17 | Nasser et al., 2018[ | 36 | 31 | HSV-2 | Acyclovir | survive | death |
18 | Neistadt et al., 2018[ | NS | 27 | NK/T-cell lymphoma | Corticosteroids, etoposide, pembrolizumab | death | death |
19 | Parrott et al., 2019[ | 28 | 18 | Lupus | No response to etoposide and corticosteroid | death | death |
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3. |
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7. |
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8. |
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9. |
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10. |
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11. |
Teng CL, Hwang GY, Lee BJ, et al. Pregnancy-induced hemophagocytic lymphohistiocytosis combined with autoimmune hemolytic anemia. J Chin Med Assoc 2009; 72(3):156-9. doi: 10.1016/s1726-4901(09)70043-7.
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12. |
Arewa OP, Ajadi AA. Human immunodeficiency virus associated with haemophagocytic syndrome in pregnancy: a case report. West Afr J Med 2011; 30(1):66-8. doi: 10.4314/wajm.v30i1.69922.
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13. |
Shukla A, Kaur A, Hira HS. Pregnancy induced haemophagocytic syndrome. J Obstet Gynaecol India 2013; 63(3):203-5. doi: 10.1007/s13224-011-0073-0.
doi: 10.1007/s13224-011-0073-0 pmid: 24431639 |
14. |
Goulding EA, Barnden KR. Disseminated herpes simplex virus manifesting as pyrexia and cervicitis and leading to reactive hemophagocytic syndrome in pregnancy. Eur J Obstet Gynecol Reprod Biol 2014; 180:198-9. doi: 10.1016/j.ejogrb.2014.05.005.
pmid: 24890680 |
15. |
Mayama M, Yoshihara M, Kokabu T, et al. Hemophagocytic lymphohistiocytosis associated with a parvovirus B19 infection during pregnancy. Obstet Gynecol 2014; 124(2 Pt 2 Suppl 1):438-41. doi: 10.1097/aog.0000000000000385.
pmid: 25004318 |
16. |
Klein S, Schmidt C, La Rosée P, et al. Fulminant gastrointestinal bleeding caused by EBV-triggered hemophagocytic lymphohistiocytosis: report of a case. Z Gastroenterol 2014; 52(4):354-9. doi: 10.1055/s-0034-1366154.
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17. |
Tumian NR, Wong CL. Pregnancy-related hemophagocytic lymphohistiocytosis associated with cytomegalovirus infection: A diagnostic and therapeutic challenge. Taiwan J Obstet Gynecol 2015; 54(4):432-7. doi: 10.1016/j.tjog.2014.11.023.
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18. |
Giard JM, Decker KA, Lai JC, et al. Acute liver failure secondary to hemophagocytic lymphohistiocytosis during pregnancy. ACG Case Rep J 2016; 3(4):e162. doi: 10.14309/crj.2016.135.
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19. |
Rousselin A, Alavi Z, Le Moigne E, et al. Hemophagocytic syndrome in pregnancy: case report, diagnosis, treatment, and prognosis. Clin Case Rep 2017; 5(11):1756-64. doi: 10.1002/ccr3.1172.
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20. |
He M, Jia J, Zhang J, et al. Pregnancy-associated hemophagocytic lymphohistiocytosis secondary to NK/T cells lymphoma: A case report and literature review. Medicine (Baltimore) 2017; 96(47):e8628. doi: 10.1097/md.0000000000008628.
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21. |
Ikeda M, Oba R, Yoshiki Y, et al. Epstein-barr virus-associated hemophagocytic lymphohistiocytosis during pregnancy. Rinsho Ketsueki 2017; 58(3):216-21. doi: 10.11406/rinketsu.58.216.
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22. |
Yildiz H, Vandercam B, Thissen X, et al. Hepatitis during pregnancy: A case of hemophagocytic lymphohistiocytosis. Clin Res Hepatol Gastroenterol 2018; 42(3):e49-55. doi: 10.1016/j.clinre.2017.10.007.
pmid: 29239849 |
23. |
Wang LY, Hu J, Ramsingh G, et al. A case of recurrent pregnancy-induced adult onset familial hemophagocytic lymphohistiocytosis. World J Oncol 2018; 9(4):123-7. doi: 10.14740/wjon1145w.
doi: 10.14740/wjon1145w pmid: 30220951 |
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