Hemophagocytic lymphohistiocytosis complicating invasive pneumococcal disease: A pediatric case report

Mitsuru Tsuge, Machiko Miyamoto, Reiji Miyawaki, Yoichi Kondo, Hirokazu Tsukahara

Research output: Contribution to journalArticle

Abstract

Background: Hemophagocytic lymphohistiocytosis (HLH) is an infrequent but life-threatening disease due to excessive immune activation. Secondary HLH can be triggered by infections, autoimmune diseases, and malignant diseases. Streptococcus pneumoniae is a pathogenic bacterium responsible for invasive pneumococcal disease (IPD) such as meningitis and bacteremia. Although the pneumococcal conjugate vaccine (PCV) has led to reductions in IPD incidence, cases of IPD caused by serotypes not included in PCV are increasing. There are few reports of secondary HLH caused by IPD in previously healthy children. We herein report a rare case of a previously healthy boy with secondary HLH complicating IPD of serotype 23A, which is not included in the pneumococcal 13-valent conjugate vaccine (PCV-13). Case presentation: An 11-month-old boy who had received three doses of PCV-13 was hospitalized with prolonged fever, bilateral otitis media, neutropenia and elevated C-reactive protein (CRP) levels. Blood culture on admission revealed S. pneumoniae, leading to a diagnosis of IPD. HLH was diagnosed based on a prolonged fever, neutropenia, anemia, hepatosplenomegaly, hemophagocytosis in the bone marrow, and elevated serum levels of triglycerides, ferritin, and soluble interleukin-2 receptor. He received broad-spectrum antibiotics and intravenous immunoglobulins for IPD and high-dose steroid pulse therapy and cyclosporine A for HLH; thereafter, his fever resolved, and laboratory findings improved. The serotype of the isolated S. pneumoniae was 23A, which is not included in PCV-13. Conclusions: It is important to consider secondary HLH as a complication of IPD cases with febrile cytopenia or hepatosplenomegaly, and appropriate treatment for HLH should be started without delay.

Original languageEnglish
Article number15
JournalBMC Pediatrics
Volume20
Issue number1
DOIs
Publication statusPublished - Jan 13 2020

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Hemophagocytic Lymphohistiocytosis
Conjugate Vaccines
Pediatrics
Pneumococcal Vaccines
Fever
Streptococcus pneumoniae
Neutropenia
Interleukin-2 Receptors
Intravenous Immunoglobulins
Otitis Media
Ferritins
Bacteremia
Meningitis
C-Reactive Protein
Cyclosporine
Autoimmune Diseases
Anemia
Triglycerides
Bone Marrow
Steroids

Keywords

  • Child
  • Hemophagocytic lymphohistiocytosis
  • Invasive pneumococcal disease
  • Pneumococcal conjugate vaccine
  • Serotype replacement

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Hemophagocytic lymphohistiocytosis complicating invasive pneumococcal disease : A pediatric case report. / Tsuge, Mitsuru; Miyamoto, Machiko; Miyawaki, Reiji; Kondo, Yoichi; Tsukahara, Hirokazu.

In: BMC Pediatrics, Vol. 20, No. 1, 15, 13.01.2020.

Research output: Contribution to journalArticle

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abstract = "Background: Hemophagocytic lymphohistiocytosis (HLH) is an infrequent but life-threatening disease due to excessive immune activation. Secondary HLH can be triggered by infections, autoimmune diseases, and malignant diseases. Streptococcus pneumoniae is a pathogenic bacterium responsible for invasive pneumococcal disease (IPD) such as meningitis and bacteremia. Although the pneumococcal conjugate vaccine (PCV) has led to reductions in IPD incidence, cases of IPD caused by serotypes not included in PCV are increasing. There are few reports of secondary HLH caused by IPD in previously healthy children. We herein report a rare case of a previously healthy boy with secondary HLH complicating IPD of serotype 23A, which is not included in the pneumococcal 13-valent conjugate vaccine (PCV-13). Case presentation: An 11-month-old boy who had received three doses of PCV-13 was hospitalized with prolonged fever, bilateral otitis media, neutropenia and elevated C-reactive protein (CRP) levels. Blood culture on admission revealed S. pneumoniae, leading to a diagnosis of IPD. HLH was diagnosed based on a prolonged fever, neutropenia, anemia, hepatosplenomegaly, hemophagocytosis in the bone marrow, and elevated serum levels of triglycerides, ferritin, and soluble interleukin-2 receptor. He received broad-spectrum antibiotics and intravenous immunoglobulins for IPD and high-dose steroid pulse therapy and cyclosporine A for HLH; thereafter, his fever resolved, and laboratory findings improved. The serotype of the isolated S. pneumoniae was 23A, which is not included in PCV-13. Conclusions: It is important to consider secondary HLH as a complication of IPD cases with febrile cytopenia or hepatosplenomegaly, and appropriate treatment for HLH should be started without delay.",
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