Cytomegalovirus pneumonitis-induced secondary hemophagocytic lymphohistiocytosis and SIADH in an immunocompetent elderly male literature review

Sachin M Patil; Phillip Paul Beck; Tarang Pankaj Patel; Michael P Hunter; Jeremy Johnson; Bran Andres Acevedo; William Roland

doi:10.1016/j.idcr.2020.e00972

Cytomegalovirus pneumonitis-induced secondary hemophagocytic lymphohistiocytosis and SIADH in an immunocompetent elderly male literature review

IDCases. 2020:22:e00972. doi: 10.1016/j.idcr.2020.e00972. Epub 2020 Oct 2.

Authors

Sachin M Patil^{1

2}, Phillip Paul Beck^{1

2}, Tarang Pankaj Patel^{1

3}, Michael P Hunter^{1

3}, Jeremy Johnson^{1

3}, Bran Andres Acevedo^{1

2}, William Roland^{1

2}

Affiliations

¹ University of Missouri Hospital and Clinic, 1 Hospital Dr, Columbia, MO 65212, USA.
² Department of Medicine, Division of Infectious Diseases, USA.
³ Department of Medicine, Division of Pulmonary, Critical Care and Environmental Medicine, USA.

Abstract

Hemophagocytic lymphohistiocytosis (HLH) is also known as hemophagocytic syndrome. It is a lethal hematologic condition due to a dysregulated immune response which results in inappropriately activated macrophages damaging host tissues. Based on the etiology, HLH can be primary (genetic) or secondary (acquired). The most common cause of a secondary HLH is an infection. Viral infections are the most common cause of secondary HLH. Among the viral causes of secondary HLH, Epstein-Barr virus is the most common etiologic agent. Cytomegalovirus (CMV) is a common causative pathogen in the immunocompromised host but is rare in an immunocompetent adult. In infection- associated secondary HLH, treatment includes antimicrobial therapy. HLH carries a high mortality and morbidity rate as it is an underdiagnosed clinical condition. Successful early diagnosis allows for adequate time for curative therapy. Treatment for HLH includes chemotherapy, immunomodulators, and a hematopoietic stem-cell transplant. The 2004 diagnostic criteria set by the Histiocyte Society serves as a guide to make an earlier clinical diagnosis. A review of PubMed literature revealed only five reported cases of CMV-induced HLH. We describe the sixth case of CMV pneumonitis-induced HLH and syndrome of inappropriate antidiuretic hormone secretion in a 72-year-old White male. He was treated successfully with oral valganciclovir and corticosteroids.

Keywords: CMV; HLH; Immunocompetent; Pneumonitis.

Publication types

Case Reports