Hemophagocytic Lymphohistiocytosis Associated With Cytomegalovirus Infection: 5 Cases and a Systematic Review of the Literature

被引:7
作者
Chevalier, Kevin [1 ]
Schmidt, Julien [1 ]
Coppo, Paul [2 ]
Galicier, Lionel [3 ]
Noel, Nicolas [1 ]
Lambotte, Olivier [1 ]
机构
[1] Univ Paris Saclay, Hop Bicetre, AP HP,Ctr Rech Immunol Infect Virales & Malad Aut, Serv Med Interne Immunol Clin,CEA,UMR1184,INSERM, Le Kremlin Bicetre, France
[2] Sorbonne Univ, Hop St Antoine, AP HP, Serv Hematol Clin & Therapie Cellulaire, Paris, France
[3] Univ Paris Cite, Hop St Louis, AP HP, Serv Immunol Clin, Paris, France
关键词
hemophagocytic lymphohistiocytosis; cytomegalovirus; CMV; immunocompetent; NECROSIS-FACTOR ANTAGONISTS; DISEASE; THIOPURINES;
D O I
10.1093/cid/ciac649
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening disorder characterized by an uncontrolled, persistent, hyperimmune response. It can be triggered by an infectious, neoplastic, or autoimmune event. The involvement of cytomegalovirus (CMV) in the onset of HLH is subject to debate, and the epidemiology of CMV-associated HLH (HLH-CMV) remains poorly characterized. We identified 5 cases of HLH-CMV in our hospital, systematically searched the PubMed database for publications on HLH-CMV, and reviewed 57 publications with a total of 67 cases of HLH-CMV. Only 48 patients (71.6%) were immunodeficient, suggesting that HLH-CMV can occur in immunocompetent patients. The major cause of underlying immunodepression (51%) was inflammatory bowel disease (mainly treated with azathioprine). CMV infection was nearly always symptomatic, and lung involvement was frequent (31 cases). Fifty-five patients recovered. Nineteen patients were treated for CMV infection only and had a good outcome, suggesting that antiviral drugs might be the cornerstone of HLH-CMV treatment. Hemophagocytic lymphohistiocytosis (HLH) can be triggered by cytomegalovirus (CMV). HLH after CMV infection can occur in immunocompetent patients. CMV infection is nearly always symptomatic, and lung involvement is frequent. Antiviral drugs might be the cornerstone of treatment.
引用
收藏
页码:351 / 358
页数:8
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