Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare condition with high mortality. We report a case of a 74-year-old woman with rheumatoid arthritis who developed HLH secondary to pyelonephritis due to Escherichia coli infection following infliximab treatment. Bone marrow aspiration showed proliferation of histiocytes with hemophagocytosis. The patient died despite treatment with intravenous antibiotics intravenous methylprednisolone and intravenous immunoglobulin. Cytokine levels were measured and are discussed.
MeSH terms
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Aged
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Anti-Bacterial Agents / therapeutic use
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Antibodies, Monoclonal / adverse effects*
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Antibodies, Monoclonal / therapeutic use
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Antirheumatic Agents / adverse effects*
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Antirheumatic Agents / therapeutic use
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Arthritis, Rheumatoid / complications*
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Arthritis, Rheumatoid / drug therapy
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Arthritis, Rheumatoid / immunology
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Bone Marrow / pathology
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Escherichia coli Infections / complications*
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Escherichia coli Infections / drug therapy
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Fatal Outcome
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Female
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Histiocytes / pathology
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Humans
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Immunocompromised Host
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Immunoglobulins, Intravenous / therapeutic use
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Immunosuppressive Agents / adverse effects*
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Immunosuppressive Agents / therapeutic use
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Infliximab
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Lymphohistiocytosis, Hemophagocytic / etiology*
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Meropenem
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Methylprednisolone / therapeutic use
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Pyelonephritis / complications*
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Pyelonephritis / drug therapy
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Thienamycins / therapeutic use
Substances
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Anti-Bacterial Agents
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Antibodies, Monoclonal
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Antirheumatic Agents
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Immunoglobulins, Intravenous
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Immunosuppressive Agents
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Thienamycins
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Infliximab
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Meropenem
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Methylprednisolone