Secondary hemophagocytic lymphohistiocytosis triggered by Staphylococcus aureus bacteremia: A case report and systemic review
Shih-Hao Chung,
Yen-Yu Liu,
Shih-Ya Huang,
Meng-Ta Sung,
Alice Ying-Jung Wu
Affiliations
Shih-Hao Chung
Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
Yen-Yu Liu
Cardiovascular Center, and Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine and Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan
Shih-Ya Huang
Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
Meng-Ta Sung
Division of Hematology and Oncology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Correspondence to: Division of Hematology and Oncology, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamsui District, New Taipei City 251404, Taiwan.
Alice Ying-Jung Wu
Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan; Correspondence to: Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamsui District, New Taipei City 251404, Taiwan.
Adult haemophagocytic lymphohistiocytosis (HLH) is an infrequent and life-threatening condition. The most common triggers of HLH are malignancy and virus, and bacterial infections are rarely implicated. We present a case of HLH secondary to Staphylococcus aureus infection and systemically searched the PubMed database for publications on HLH associated with Staphylococcus aureus infection and reviewed nine cases from seven studies. A marked third of patients had infective endocarditis, while the mortality rate was 44 %. HLH developed in our case despite elimination of MRSA from the bloodstream, leading to eventual demise of our patient, suggesting that prolonged hyperimmune response may persist even after the elimination of initial triggering factor. Our case highlights the necessity of high clinical suspicion and prompt diagnosis of HLH.
