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. 2016 Mar 22:5:361.
doi: 10.1186/s40064-016-2010-2. eCollection 2016.

Severe fever with thrombocytopenia syndrome presenting as hemophagocytic syndrome: two case reports

Akihito Kitao  1 , Ryuji Ieki  2 , Hiroki Takatsu  3 , Yuki Tachibana  3 , Masaaki Nagae  3 , Takuya Hino  3 , Hitoshi Nakaji  2 , Masayuki Shimojima  4 , Masayuki Saijo  4 , Masanobu Okayama  5 , Tsuneaki Kenzaka  6
Affiliations

Severe fever with thrombocytopenia syndrome presenting as hemophagocytic syndrome: two case reports

Akihito Kitao et al. Springerplus. .

Abstract

Introduction: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that was first reported in China in 2011. However, it is now endemic in Japan, and the SFTS viruses in Japan and China have evolved independently. Its fatality rate is 26.5 % in Japan, and the viral load is related to morbidity.

Case description: We encountered two patients with SFTS. Case 1 is a 72-year-old woman who visited our hospital owing to severe fatigue, diarrhea, and nausea. Her consciousness level score on the Glasgow Coma Scale was 14 points, and her serum lactate dehydrogenase level was 646 IU/L. Case 2 is an 82-year-old woman who visited our hospital owing to diarrhea and general fatigue. Her consciousness level score on the Glasgow Coma Scale was 11 points, and her serum lactate dehydrogenase level was 935 IU/L.

Discussion and evaluation: Both patients had hemophagocytic syndrome and presented with similar symptoms. Although both were treated with similar drug regimens, their clinical courses were different: after treatment, the 72-year-old woman survived whereas the 82-year-old woman died. In addition to age, the two patients differed in terms of time between symptom onset and treatment initiation, consciousness level, viral load, and extent of elevation of liver enzyme levels.

Conclusions: The viral load, which is a predictor of morbidity, was associated with the level of consciousness and the serum lactate dehydrogenase level, both of which might be useful for predicting death in patients with SFTS.

Keywords: Consciousness level; Hemophagocytic syndrome; Severe fever with thrombocytopenia syndrome; Ticks.

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Figures

Fig. 1
Fig. 1
Bone marrow smear findings for case 1. Red blood cells are ingested by a macrophage (May-Giemsa staining, ×400 magnification)
Fig. 2
Fig. 2
Tick biting the left popliteal fossa in case 1. The patient had red flares around the bite site
Fig. 3
Fig. 3
SFTS viral genome analysis by RT-PCR for case 1. Primer sets were prepared for the Japanese congenital SFTS virus. To increase detection sensitivity, two primer sets for different target areas were used. Lanes 1, 3, and 5 represent the samples (serum, urine, and pharyngeal swab, respectively) taken on the day after admission. Lanes 2 and 4 represent samples (serum and urine respectively) taken 3 days after the initial test. Lanes 6 and 7 contain a negative and positive control, respectively
Fig. 4
Fig. 4
Bone marrow smear findings for case 2. Platelets are ingested by a macrophage (May-Giemsa staining, ×400 magnification)
Fig. 5
Fig. 5
SFTS viral genome analysis by RT-PCR for case 2. Primer sets were prepared for the Japanese congenital SFTS virus. To increase detection sensitivity, two primer sets for different target areas were used. Lane 1 represents a frozen serum specimen, lane 2 contains a negative control, and lane 3 contains a positive control
See this image and copyright information in PMC

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