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Secondary haemophagocytic lymphohistiocytosis triggered by postnatally acquired cytomegalovirus infection in a late preterm infant
- Source :
- Infection. 45:355-359
- Publication Year :
- 2017
- Publisher :
- Springer Science and Business Media LLC, 2017.
-
Abstract
- Haemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory condition with impairment of cytotoxic T-cells and natural killer cells. Causes in infants are mostly hereditary immune defects as well as various infectious triggering factors, amongst these cytomegalovirus (CMV). Vertical CMV transmission may occur in utero, during birth, and by breast feeding. Usually, a CMV infection transmitted via breast milk is symptomatic only in very immature preterm infants. We report on a late preterm infant born after 35 + 5 weeks of gestation with a birth weight of 1840 g, being admitted to our intensive care unit at the age of 9 weeks with acute enteritis and severe dehydration. After a prolonged recovery, the infant developed a sepsis-like condition with hyperpyrexia, hepatosplenomegaly, and pancytopenia. Combination with high ferritin levels (2809 μg/l), hypertriglyceridaemia (481 mg/dl), elevated soluble IL-2 receptor (sCD25, 9120 U/ml), and reduced perforin expression allowed diagnosis of HLH, caused by an acute CMV infection. Since connatal CMV infection had been ruled out earlier, we report the rare case of secondary HLH triggered by a postnatally acquired symptomatic CMV infection in an immunocompetent infant, most likely transmitted via breast milk. The infant was successfully treated with ganciclovir without need for immunosuppressive therapy.
- Subjects :
- Microbiology (medical)
Ganciclovir
Late preterm infant
Congenital cytomegalovirus infection
Hepatosplenomegaly
Cytomegalovirus
Breast milk
Antiviral Agents
Lymphohistiocytosis, Hemophagocytic
Enteritis
03 medical and health sciences
0302 clinical medicine
Humans
Medicine
030212 general & internal medicine
Milk, Human
business.industry
Infant, Newborn
Infant
General Medicine
medicine.disease
Pancytopenia
Treatment Outcome
Infectious Diseases
030220 oncology & carcinogenesis
Cytomegalovirus Infections
Immunology
medicine.symptom
business
Breast feeding
Infant, Premature
medicine.drug
Subjects
Details
- ISSN :
- 14390973 and 03008126
- Volume :
- 45
- Database :
- OpenAIRE
- Journal :
- Infection
- Accession number :
- edsair.doi.dedup.....50e831c7a44473b34e6c817ff6c16042