Severe COVID-19-Induced Hemophagocytic Lymphohistiocytosis

We reported a case of secondary hemophagocytic lymphohistiocytosis (HLH), a rare and life-threatening condition, which was suspected to have been triggered by a severe case of coronavirus disease 2019 (COVID-19). A 50-year-old man with a past medical history of ulcerative colitis with recent pancolitis status post colectomy and ileostomy two weeks before presentation presented to the emergency department with one week of subjective fevers, weakness, watery diarrhea, and decreased oral intake. A CT scan showed fluid in the rectum and post-surgical changes from his recent colectomy along with diffuse reticulonodular opacities of the lungs. His COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR) test was positive. Over the subsequent days, the patient's condition worsened as he developed worsening acute hypoxic respiratory failure with diffuse lymphadenopathy, splenomegaly, worsening cytopenias, and increased ferritin of >100,000 ng/ml on hospital day six. Hematology oncology was consulted and he was started on empiric steroid therapy followed by etoposide. However, his condition continued to worsen, and eventually, the patient passed away on hospital day eight.

Automated summary

We reported a case of secondary hemophagocytic lymphohistiocytosis (HLH) believed to be triggered by severe COVID-19. The patient, a 50-year-old man with a history of ulcerative colitis, presented with fevers, weakness, watery diarrhea, and decreased oral intake. Imaging showed lung abnormalities and the COVID-19 test was positive. Despite treatment with steroids and etoposide, the patient's condition worsened and he eventually died on the eighth day of hospitalization.