International Journal of Infectious Diseases (Feb 2021)
Secondary hemophagocytic lymphohistiocytosis and severe liver injury induced by hepatic SARS-CoV-2 infection unmasking Wilson’s disease: Balancing immunosuppression
- Matthias Lubnow,
- Barbara Schmidt,
- Martin Fleck,
- Bernd Salzberger,
- Thomas Müller,
- Georg Peschel,
- Roland Schneckenpointner,
- Tobias Lange,
- Florian Hitzenbichler,
- Martin Kieninger,
- Dirk Lunz,
- Bernhard Graf,
- Christoph Brochhausen,
- Florian Weber,
- Florian Lüke,
- David Peterhoff,
- Philipp Schuster,
- Andreas Hiergeist,
- Robert Offner,
- Ute Hehr,
- Stefan Wallner,
- Frank Hanses,
- Stephan Schmid,
- Kilian Weigand,
- Florian Geismann,
- Hendrik Poeck,
- Tobias Pukrop,
- Matthias Evert,
- Andre Gessner,
- Ralph Burkhardt,
- Wolfgang Herr,
- Lars S. Maier,
- Daniel Heudobler
Affiliations
- Matthias Lubnow
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany; Corresponding author at: Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, DE-93053 Regensburg, Germany.
- Barbara Schmidt
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany; Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
- Martin Fleck
- Department of Rheumatology, University Hospital Regensburg, Regensburg, Germany
- Bernd Salzberger
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
- Thomas Müller
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- Georg Peschel
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
- Roland Schneckenpointner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- Tobias Lange
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- Florian Hitzenbichler
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
- Martin Kieninger
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
- Dirk Lunz
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
- Bernhard Graf
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
- Christoph Brochhausen
- Institute of Pathology, University of Regensburg, Regensburg, Germany
- Florian Weber
- Institute of Pathology, University of Regensburg, Regensburg, Germany
- Florian Lüke
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
- David Peterhoff
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
- Philipp Schuster
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
- Andreas Hiergeist
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
- Robert Offner
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
- Ute Hehr
- Institute for Human Genetics, University Hospital Regensburg, Regensburg, Germany
- Stefan Wallner
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
- Frank Hanses
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany; Department of Emergency Medicine, University Hospital Regensburg, Regensburg, Germany
- Stephan Schmid
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
- Kilian Weigand
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
- Florian Geismann
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- Hendrik Poeck
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
- Tobias Pukrop
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany; Bavarian Center for Cancer Research, Regensburg, Germany
- Matthias Evert
- Institute of Pathology, University of Regensburg, Regensburg, Germany
- Andre Gessner
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
- Ralph Burkhardt
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
- Wolfgang Herr
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
- Lars S. Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- Daniel Heudobler
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany; Bavarian Center for Cancer Research, Regensburg, Germany; Corresponding author at: Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, DE-93053 Regensburg, Germany.
- Journal volume & issue
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Vol. 103
pp. 624 – 627
Abstract
A 21-year-old woman was hospitalized due to coronavirus disease 2019 (COVID-19)-associated respiratory and hepatic impairment concomitant with severe hemolytic anemia. Upon diagnosis of secondary hemophagocytic lymphohistiocytosis, immunosuppression with anakinra and steroids was started, leading to a hepatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and viremia. Subsequent liver biopsy revealed virus particles in hepatocytes by electron microscopy and SARS-CoV-2 virus could be isolated and cultured. Immunosuppression was stopped and convalescent donor plasma given. In the differential diagnosis, an acute crisis of Wilson’s disease was raised by laboratory and genetic testing. This case highlights the complexity of balancing immunosuppression to control hyperinflammation versus systemic SARS-CoV-2 dissemination.
