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ID 58244
フルテキストURL
著者
Tsuge, Mitsuru Department of Pediatrics, Okayama University Graduate School of Medicine,Dentistry, and Pharmaceutical Sciences ORCID Kaken ID researchmap
Miyamoto, Machiko Department of Pediatrics, Matsuyama Red Cross Hospital
Miyawaki, Reiji Department of Pediatrics,Ehime University Graduate School of Medicine
Kondo, Yoichi Department of Pediatrics, Matsuyama Red Cross Hospital
Tsukahara, Hirokazu Department of Pediatrics, Matsuyama Red Cross Hospital Kaken ID publons researchmap
抄録
Background
Hemophagocytic lymphohistiocytosis (HLH) is an infrequent but life-threatening disease due to excessive immune activation. Secondary HLH can be triggered by infections, autoimmune diseases, and malignant diseases. Streptococcus pneumoniae is a pathogenic bacterium responsible for invasive pneumococcal disease (IPD) such as meningitis and bacteremia. Although the pneumococcal conjugate vaccine (PCV) has led to reductions in IPD incidence, cases of IPD caused by serotypes not included in PCV are increasing. There are few reports of secondary HLH caused by IPD in previously healthy children. We herein report a rare case of a previously healthy boy with secondary HLH complicating IPD of serotype 23A, which is not included in the pneumococcal 13-valent conjugate vaccine (PCV-13).
Case presentation
An 11-month-old boy who had received three doses of PCV-13 was hospitalized with prolonged fever, bilateral otitis media, neutropenia and elevated C-reactive protein (CRP) levels. Blood culture on admission revealed S. pneumoniae, leading to a diagnosis of IPD. HLH was diagnosed based on a prolonged fever, neutropenia, anemia, hepatosplenomegaly, hemophagocytosis in the bone marrow, and elevated serum levels of triglycerides, ferritin, and soluble interleukin-2 receptor. He received broad-spectrum antibiotics and intravenous immunoglobulins for IPD and high-dose steroid pulse therapy and cyclosporine A for HLH; thereafter, his fever resolved, and laboratory findings improved. The serotype of the isolated S. pneumoniae was 23A, which is not included in PCV-13.
Conclusions
It is important to consider secondary HLH as a complication of IPD cases with febrile cytopenia or hepatosplenomegaly, and appropriate treatment for HLH should be started without delay.
キーワード
Child
Hemophagocytic lymphohistiocytosis
Invasive pneumococcal disease
Pneumococcal conjugate vaccine
Serotype replacement
発行日
2020-01-13
出版物タイトル
BMC Pediatrics
20巻
1号
出版者
BMC
ISSN
1471-2431
資料タイプ
学術雑誌論文
言語
English
OAI-PMH Set
岡山大学
著作権者
© The Author(s). 2020
論文のバージョン
publisher
PubMed ID
DOI
Web of Science KeyUT
関連URL
isVersionOf https://doi.org/10.1186/s12887-020-1915-7
ライセンス
http://creativecommons.org/licenses/by/4.0/