Fulminant hemophagocytic lymphohistiocytosis induced by pandemic A (H1N1) influenza: a case report

Abstract

Introduction: Hemophagocytic lymphohistiocytosis induced by viral diseases is a well recognized entity. Severe forms of H5N1 influenza are known to be associated with symptoms very similar to a reactive hemophagocytic syndrome. We report a case of fulminant lymphohistiocytosis associated with the pandemic A (H1N1) variant.

Case presentation: A 42-year-old Caucasian woman developed a syndrome of fatal hemophagocytic lymphohistiocytosis shortly after H1N1 influenza. Initial symptoms of the viral disease were unusual, with acute abdominal involvement. Our patient's course was complicated by diffuse skin rash and ileal ischemia. Our patient died of refractory shock and multi-organ failure. Skin, ileum and colon histology was consistent with an acute apoptosis combined with an increased cellular regeneration.

Conclusions: Influenza may be complicated by severe forms of hemophagocytic lymphohistiocytosis. To ensure early recognition and treatment, physicians should be aware of the possible induction of the syndrome by the novel H1N1 variant. The rapid occurrence of a multi-organ involvement with evocative biological features of macrophage activation should alert clinicians.

Figure 1

Photography of skin and colon microscopic pathology. A) Skin biopsy (hematoxylin and eosin stain, ×200): an important epidermal apoptosis (black arrow) associated with basal cell hydropic degeneration can be seen in the epidermis. B) Colon: (hematoxylin and eosin stain, ×400): an increased number of apoptotic bodies combined with an increased cellular regeneration can be seen; crypt proliferative zones include many apoptotic bodies (black arrow).