tetano
Editor, Senior Moderator
Immunol Med
. 2024 Apr 15:1-8.
doi: 10.1080/25785826.2024.2338594. Online ahead of print. Fetal hemophagocytic lymphohistiocytosis with intravascular large B-cell lymphoma following coronavirus disease 2019 vaccination in a patient with systemic lupus erythematosus: an intertwined case
Yusuke Ueda[SUP] 1 [/SUP], Tomoyuki Sakai[SUP] 1 [/SUP], Kazunori Yamada[SUP] 1 2 [/SUP], Kotaro Arita[SUP] 1 [/SUP], Yoko Ishige[SUP] 3 [/SUP], Daisuke Hoshi[SUP] 4 [/SUP], Hiroto Yanagisawa[SUP] 1 [/SUP], Haruka Iwao-Kawanami[SUP] 1 [/SUP], Takafumi Kawanami[SUP] 1 [/SUP], Shuichi Mizuta[SUP] 1 [/SUP], Toshihiro Fukushima[SUP] 1 [/SUP], Sohsuke Yamada[SUP] 5 [/SUP], Akihiro Yachie[SUP] 6 [/SUP], Yasufumi Masaki[SUP] 1 [/SUP]
Affiliations
Hemophagocytic lymphohistiocytosis (HLH) has been recognized as a rare adverse event following the coronavirus disease 2019 (COVID-19) vaccination. We report a case of neuropsychiatric symptoms and refractory HLH in a woman with systemic lupus erythematosus (SLE) after receiving her COVID-19 vaccine treated with belimumab, later found to have intravascular large B-cell lymphoma (IVLBCL) at autopsy. A 61-year-old woman with SLE was referred to our hospital because of impaired consciousness and fever. One month prior to consulting, she received her second COVID-19 vaccine dose. Afterward, her consciousness level decreased, and she developed a high fever. She tested negative for SARS-CoV-2. Neuropsychiatric SLE was suspected; therefore, glucocorticoid pulse therapy was initiated on day 1 and 8. She had thrombocytopenia, increased serum ferritin levels and hemophagocytosis. The patient was diagnosed with HLH and treated with etoposide, dexamethasone and cyclosporine. Despite treatment, the patient died on day 75; autopsy report findings suggested IVLBCL as the underlying cause of HLH. Differentiating comorbid conditions remains difficult; however, in the case of an atypical clinical presentation, other causes should be considered. Therefore, we speculate that the COVID-19 vaccination and her autoimmune condition may have expedited IVLBCL development.
Keywords: COVID-19; hemophagocytic lymphohistiocytosis; intravascular large B-cell lymphoma; systemic lupus erythematosus; vaccination.
. 2024 Apr 15:1-8.
doi: 10.1080/25785826.2024.2338594. Online ahead of print. Fetal hemophagocytic lymphohistiocytosis with intravascular large B-cell lymphoma following coronavirus disease 2019 vaccination in a patient with systemic lupus erythematosus: an intertwined case
Yusuke Ueda[SUP] 1 [/SUP], Tomoyuki Sakai[SUP] 1 [/SUP], Kazunori Yamada[SUP] 1 2 [/SUP], Kotaro Arita[SUP] 1 [/SUP], Yoko Ishige[SUP] 3 [/SUP], Daisuke Hoshi[SUP] 4 [/SUP], Hiroto Yanagisawa[SUP] 1 [/SUP], Haruka Iwao-Kawanami[SUP] 1 [/SUP], Takafumi Kawanami[SUP] 1 [/SUP], Shuichi Mizuta[SUP] 1 [/SUP], Toshihiro Fukushima[SUP] 1 [/SUP], Sohsuke Yamada[SUP] 5 [/SUP], Akihiro Yachie[SUP] 6 [/SUP], Yasufumi Masaki[SUP] 1 [/SUP]
Affiliations
- PMID: 38619098
- DOI: 10.1080/25785826.2024.2338594
Hemophagocytic lymphohistiocytosis (HLH) has been recognized as a rare adverse event following the coronavirus disease 2019 (COVID-19) vaccination. We report a case of neuropsychiatric symptoms and refractory HLH in a woman with systemic lupus erythematosus (SLE) after receiving her COVID-19 vaccine treated with belimumab, later found to have intravascular large B-cell lymphoma (IVLBCL) at autopsy. A 61-year-old woman with SLE was referred to our hospital because of impaired consciousness and fever. One month prior to consulting, she received her second COVID-19 vaccine dose. Afterward, her consciousness level decreased, and she developed a high fever. She tested negative for SARS-CoV-2. Neuropsychiatric SLE was suspected; therefore, glucocorticoid pulse therapy was initiated on day 1 and 8. She had thrombocytopenia, increased serum ferritin levels and hemophagocytosis. The patient was diagnosed with HLH and treated with etoposide, dexamethasone and cyclosporine. Despite treatment, the patient died on day 75; autopsy report findings suggested IVLBCL as the underlying cause of HLH. Differentiating comorbid conditions remains difficult; however, in the case of an atypical clinical presentation, other causes should be considered. Therefore, we speculate that the COVID-19 vaccination and her autoimmune condition may have expedited IVLBCL development.
Keywords: COVID-19; hemophagocytic lymphohistiocytosis; intravascular large B-cell lymphoma; systemic lupus erythematosus; vaccination.