tetano
Editor, Senior Moderator
Am J Clin Pathol
. 2020 Jul 18;aqaa124.
doi: 10.1093/ajcp/aqaa124. Online ahead of print.
SARS-CoV-2 Infection-Associated Hemophagocytic Lymphohistiocytosis
Andrey Prilutskiy[SUP] 1 [/SUP], Michael Kritselis[SUP] 1 [/SUP], Artem Shevtsov[SUP] 1 [/SUP], Ilyas Yambayev[SUP] 1 [/SUP], Charitha Vadlamudi[SUP] 1 [/SUP], Qing Zhao[SUP] 1 [/SUP], Yachana Kataria[SUP] 1 [/SUP], Shayna R Sarosiek[SUP] 2 [/SUP], Adam Lerner[SUP] 2 [/SUP], J Mark Sloan[SUP] 2 [/SUP], Karen Quillen[SUP] 2 [/SUP], Eric J Burks[SUP] 1 [/SUP]
Affiliations
Abstract
Objectives: A subset of coronavirus disease 2019 (COVID-19) patients exhibit clinical features of cytokine storm. However, clinicopathologic features diagnostic of hemophagocytic lymphohistiocytosis (HLH) have not been reported. We studied the reticuloendothelial organs of 4 consecutive patients who died of COVID-19 and correlated with clinical and laboratory parameters to detect HLH.
Methods: Autopsies were performed on 4 patients who died of COVID-19. Routine H&E staining and immunohistochemical staining for CD163 were performed to detect hemophagocytosis. Clinical and laboratory results from premortem blood samples were used to calculate H-scores.
Results: All 4 cases demonstrated diffuse alveolar damage within the lungs. Three of the 4 cases had histologic evidence of hemophagocytosis within pulmonary lymph nodes. One case showed hemophagocytosis in the spleen but none showed hemophagocytosis in liver or bone marrow. Lymphophagocytosis was the predominant form of hemophagocytosis observed. One patient showed diagnostic features of HLH with an H-score of 217, while a second patient likely had HLH with a partial H-score of 145 due to a missing triglyceride level. The remaining 2 patients had H-scores of 131 and 96.
Conclusions: This is the first report of severe acute respiratory syndrome coronavirus 2-associated HLH. Identification of HLH in a subset of patients with severe COVID-19 will inform clinical trials of therapeutic strategies.
Keywords: 2019-nCoV; Autopsy; COVID-19; Coronavirus; HLH; Hemophagocytic lymphohistiocytosis; Hemophagocytosis; SARS-CoV-2.
. 2020 Jul 18;aqaa124.
doi: 10.1093/ajcp/aqaa124. Online ahead of print.
SARS-CoV-2 Infection-Associated Hemophagocytic Lymphohistiocytosis
Andrey Prilutskiy[SUP] 1 [/SUP], Michael Kritselis[SUP] 1 [/SUP], Artem Shevtsov[SUP] 1 [/SUP], Ilyas Yambayev[SUP] 1 [/SUP], Charitha Vadlamudi[SUP] 1 [/SUP], Qing Zhao[SUP] 1 [/SUP], Yachana Kataria[SUP] 1 [/SUP], Shayna R Sarosiek[SUP] 2 [/SUP], Adam Lerner[SUP] 2 [/SUP], J Mark Sloan[SUP] 2 [/SUP], Karen Quillen[SUP] 2 [/SUP], Eric J Burks[SUP] 1 [/SUP]
Affiliations
- PMID: 32681166
- DOI: 10.1093/ajcp/aqaa124
Abstract
Objectives: A subset of coronavirus disease 2019 (COVID-19) patients exhibit clinical features of cytokine storm. However, clinicopathologic features diagnostic of hemophagocytic lymphohistiocytosis (HLH) have not been reported. We studied the reticuloendothelial organs of 4 consecutive patients who died of COVID-19 and correlated with clinical and laboratory parameters to detect HLH.
Methods: Autopsies were performed on 4 patients who died of COVID-19. Routine H&E staining and immunohistochemical staining for CD163 were performed to detect hemophagocytosis. Clinical and laboratory results from premortem blood samples were used to calculate H-scores.
Results: All 4 cases demonstrated diffuse alveolar damage within the lungs. Three of the 4 cases had histologic evidence of hemophagocytosis within pulmonary lymph nodes. One case showed hemophagocytosis in the spleen but none showed hemophagocytosis in liver or bone marrow. Lymphophagocytosis was the predominant form of hemophagocytosis observed. One patient showed diagnostic features of HLH with an H-score of 217, while a second patient likely had HLH with a partial H-score of 145 due to a missing triglyceride level. The remaining 2 patients had H-scores of 131 and 96.
Conclusions: This is the first report of severe acute respiratory syndrome coronavirus 2-associated HLH. Identification of HLH in a subset of patients with severe COVID-19 will inform clinical trials of therapeutic strategies.
Keywords: 2019-nCoV; Autopsy; COVID-19; Coronavirus; HLH; Hemophagocytic lymphohistiocytosis; Hemophagocytosis; SARS-CoV-2.