Successful Recovery from Severe Fever with Thrombocytopenia Syndrome and Hemophagocytic Lymphohistiocytosis with Standard Treatment and a Calcium Channel Blocker of Nicardipine Hydrochloride

Intern Med. 2023 May 1;62(9):1365-1369. doi: 10.2169/internalmedicine.9052-21. Epub 2022 Sep 28.

Abstract

A 67-year-old man was admitted to our hospital with a high fever. Laboratory tests revealed leukopenia, thrombocytopenia, liver dysfunction, rhabdomyolysis, and hyperferritinemia. He was diagnosed with severe fever with thrombocytopenia syndrome (SFTS) complicated by hemophagocytic lymphohistiocytosis and treated with steroid therapy, intravenous calcium channel blocker (CCB), and supportive care, without favipiravir. Serum levels of ferritin and soluble interleukin 2 receptor (sIL2R) were markedly elevated on Day 3 after admission and decreased thereafter, while an SFTS viral load of 6.8×104 copies/μL was detected on Day 2, increasing to 2.9×105 copies/μL on Day 6. Serum ferritin and sIL2R levels may be better indicators of mortality than the SFTS viral load, and CCBs may have a therapeutic effect.

Keywords: calcium channel blocker; hemophagocytic lymphohistiocytosis; severe fever with thrombocytopenia syndrome.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Calcium Channel Blockers / therapeutic use
  • Ferritins
  • Humans
  • Lymphohistiocytosis, Hemophagocytic* / complications
  • Lymphohistiocytosis, Hemophagocytic* / diagnosis
  • Lymphohistiocytosis, Hemophagocytic* / drug therapy
  • Male
  • Nicardipine
  • Phlebovirus*
  • Severe Fever with Thrombocytopenia Syndrome* / complications
  • Thrombocytopenia* / complications
  • Thrombocytopenia* / drug therapy

Substances

  • Calcium Channel Blockers
  • Nicardipine
  • Ferritins