Cytomegalovirus pneumonitis-induced secondary hemophagocytic lymphohistiocytosis and SIADH in an immunocompetent elderly male literature review
Sachin M. Patil,
Phillip Paul Beck,
Tarang Pankaj Patel,
Michael P Hunter,
Jeremy Johnson,
Bran Andres Acevedo,
William Roland
Affiliations
Sachin M. Patil
University of Missouri Hospital and Clinic, 1 Hospital Dr, Columbia, MO 65212, USA; Department of Medicine, Division of Infectious Diseases, USA; Corresponding author at: University of Missouri Health Care, Department of Medicine, Division of Pulmonary, One Hospital Drive, Columbia, 65212, USA.
Phillip Paul Beck
University of Missouri Hospital and Clinic, 1 Hospital Dr, Columbia, MO 65212, USA; Department of Medicine, Division of Infectious Diseases, USA
Tarang Pankaj Patel
University of Missouri Hospital and Clinic, 1 Hospital Dr, Columbia, MO 65212, USA; Department of Medicine, Division of Pulmonary, Critical Care and Environmental Medicine, USA
Michael P Hunter
University of Missouri Hospital and Clinic, 1 Hospital Dr, Columbia, MO 65212, USA; Department of Medicine, Division of Pulmonary, Critical Care and Environmental Medicine, USA
Jeremy Johnson
University of Missouri Hospital and Clinic, 1 Hospital Dr, Columbia, MO 65212, USA; Department of Medicine, Division of Pulmonary, Critical Care and Environmental Medicine, USA
Bran Andres Acevedo
University of Missouri Hospital and Clinic, 1 Hospital Dr, Columbia, MO 65212, USA; Department of Medicine, Division of Infectious Diseases, USA
William Roland
University of Missouri Hospital and Clinic, 1 Hospital Dr, Columbia, MO 65212, USA; Department of Medicine, Division of Infectious Diseases, USA
Hemophagocytic lymphohistiocytosis (HLH) is also known as hemophagocytic syndrome. It is a lethal hematologic condition due to a dysregulated immune response which results in inappropriately activated macrophages damaging host tissues. Based on the etiology, HLH can be primary (genetic) or secondary (acquired). The most common cause of a secondary HLH is an infection. Viral infections are the most common cause of secondary HLH. Among the viral causes of secondary HLH, Epstein–Barr virus is the most common etiologic agent. Cytomegalovirus (CMV) is a common causative pathogen in the immunocompromised host but is rare in an immunocompetent adult. In infection- associated secondary HLH, treatment includes antimicrobial therapy. HLH carries a high mortality and morbidity rate as it is an underdiagnosed clinical condition. Successful early diagnosis allows for adequate time for curative therapy. Treatment for HLH includes chemotherapy, immunomodulators, and a hematopoietic stem-cell transplant. The 2004 diagnostic criteria set by the Histiocyte Society serves as a guide to make an earlier clinical diagnosis. A review of PubMed literature revealed only five reported cases of CMV-induced HLH. We describe the sixth case of CMV pneumonitis-induced HLH and syndrome of inappropriate antidiuretic hormone secretion in a 72-year-old White male. He was treated successfully with oral valganciclovir and corticosteroids.
