Fatal adenovirus serotype 21 infection associated with hemophagocytic lymphohistiocytosis and multiorgan failure

Tim Lahm , Helena N. Spartz , Dean A. Hawley , Diane S. Leland , Karen M. Wolf , Homer L. Twigg III , Michael D. Ober
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引用次数: 3

Abstract

Recent reports describe an increase in the incidence of fatal adenovirus infections. Several severe cases have been linked to adenovirus serotype 21. The exact etiology for this unexpectedly high mortality remains unknown. We report the case of a patient with severe adenovirus serotype 21 pneumonia resulting in hemophagocytic lymphohistiocytosis (HLH) with acute respiratory distress syndrome and rapidly progressive multiorgan dysfunction syndrome (MODS). HLH describes a cytokine storm due to uncontrolled accumulation of activated T-lymphocytes and activated histiocytes. This results in organ infiltration with these cells, and subsequent hemophagocytosis of erythrocytes, leukocytes and platelets. In its most severe form, HLH leads to a sepsis-like picture and MODS. The association between adenovirus 21 and HLH may at least in part explain the recently observed increase in incidence of fatal adenoviral infections. We suggest that HLH should be considered in cases of severe adenoviral infection. If HLH is present, aggressive treatment is warranted.

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致命性21型腺病毒感染与噬血细胞、淋巴组织细胞增多症和多器官功能衰竭有关
最近的报告描述了致命性腺病毒感染发生率的增加。一些严重病例与血清21型腺病毒有关。这种意外高死亡率的确切病因尚不清楚。我们报告一例严重的腺病毒血清21型肺炎,导致噬血细胞性淋巴组织细胞增多症(HLH)合并急性呼吸窘迫综合征和快速进行性多器官功能障碍综合征(MODS)。HLH描述了由于活化t淋巴细胞和活化组织细胞不受控制的积累而引起的细胞因子风暴。这导致这些细胞的器官浸润,随后红细胞、白细胞和血小板的噬血细胞作用。在最严重的情况下,HLH会导致类似败血症的症状和MODS。腺病毒21和HLH之间的联系至少可以部分解释最近观察到的致命性腺病毒感染发生率的增加。我们建议在严重腺病毒感染的病例中应考虑HLH。如果存在HLH,则需要积极治疗。
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