Journal
BMC MEDICINE
Volume 18, Issue 1, Pages -Publisher
BMC
DOI: 10.1186/s12916-020-01682-y
Keywords
Coronavirus; Coronavirus disease 2019; Hemophagocytic lymphohistiocytosis
Categories
Funding
- Polish National Science Center [UMO-2016/21/B/NZ6/02279]
- Medical University of Lublin [DS460, DS461]
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BackgroundCOVID-19, a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), commonly presents as fever, cough, dyspnea, and myalgia or fatigue. Although the majority of patients with COVID-19 have mild symptoms, some are more prone to serious outcomes, including pneumonia, acute respiratory distress syndrome (ARDS), and even death. Hemophagocytic lymphohistiocytosis (HLH) is a severe, life-threatening inflammatory syndrome associated with intense cytokine release (also known as a cytokine storm). Similar to COVID-19, HLH is characterized by aggressive course leading to multi-organ failure.Main textThe purpose of this review article is to draw attention to the possibility of the complication of HLH in patients with the severe course of COVID-19. Indeed, some of the clinical characteristics observed in the more severe cases of COVID-19 are reminiscent of secondary HLH (which can be triggered by infections, malignancies, rheumatological diseases, or autoimmune/immunodeficiency conditions). The pathogenesis of SARS-CoV-2 infection also suggests that HLH or a similar hyperinflammatory syndrome is the cause of the severe course of the infection.ConclusionThe pathogenesis and clinical symptoms of severe COVID-19 indicate that an increased inflammatory response corresponding to HLH is occurring. Therefore, patients with severe COVID-19 should be screened for hyperinflammation using standard laboratory tests to identify those for whom immunosuppressive therapy may improve outcomes.
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