Tratamiento exitoso de linfohistiocitosis hemofagocítica y coagulación intravascular diseminada secundarias a histoplasmosis en un paciente con HIV/sida
Resumen
La linfohistiocitosis hemofagocítica es un síndrome poco frecuente que resulta de una activación incontrolada de los macrófagos y linfocitos, la cual compromete múltiples órganos y es potencialmente fatal sin el tratamiento oportuno. El síndrome puede ser de origen hereditario o secundario a procesos infecciosos, neoplásicos o autoinmunitarios.
Se presenta el caso de un paciente con HIV/sida que desarrolló linfohistiocitosis hemofagocítica y coagulación intravascular diseminada asociadas a histoplasmosis, y que fue exitosamente tratado con anfotericina B, esteroides y tratamiento dialítico transitorio.
Descargas
Referencias
Janka GE, Lehmberg K. Hemophagocytic syndromes - An update. Blood Rev. 2014;28:135-42. http://dx.doi.org/10.1016/j.blre.2014.03.002.
Rouphael NG, Talati NJ, Vaughan C, Cunningham K, Moreira R, Gould C. Infections associated with haemophagocytic syndrome. Lancet Infect Dis. 2007;7:814-22. http://dx.doi.org/10.1016/S1473-3099(07)70290-6.
Larroche C. Hemophagocytic lymphohistiocytosis in adults: Diagnosis and treatment. Jt Bone Spine. 2012;79:356-61. http://dx.doi.org/10.1016/j.jbspin.2011.10.015.
Li J, Wang Q, Zheng W, Ma J, Zhang W, Wang W, et al. Hemophagocytic lymphohistiocytosis: Clinical analysis of 103 adult patients. Medicine (Baltimore). 2014;93:100-5. http://dx.doi.org/10.1097/MD.0000000000000022.
Foundation KDIGO. Clinical Guidelines. National Kidney. Section 2: AKI Definition. Kidney Int Suppl. 2012;2:19-36.
Henter J, Horne A, Aricó M, Egeler R, Filipovich A, Imashuku S, et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer. 2007;48:124-31. http://dx.doi.org/10.1002/pbc.21039.
Allen CE, Yu X, Kozinetz CA, McClain KL. Highly elevated ferritin levels and the diagnosis of hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer. 2008;50:1227-35. http://dx.doi.org/10.1002/pbc.21423.
Doyle T, Bhagani S, Cwynarski K. Haemophagocytic syndrome and HIV. Curr Opin Infect Dis. 2009;22:1-6. http://dx.doi.org/10.1097/QCO.0b013e32832180b0.
Fardet L, Lambotte O, Meynard J-L, Kamouh W, Galicier L, Marzac C, et al. Reactive haemophagocytic syndrome in 58 HIV-1-infected patients: Clinical features, underlying diseases and prognosis. AIDS. 2010;24:1299-306. http://dx.doi.org/10.1097/QAD.0b013e328339e55b.
Subedee A, van Sickels N. Hemophagocytic syndrome in the setting of AIDS and disseminated histoplasmosis: Case report and a review of literature. J Int Assoc Provid AIDS Care. 2015;1-7. http://dx.doi.org/10.1177/2325957415570740.
Nieto-Ríos JF, Aristizábal-Alzate A, Ocampo C, Serrano-Gayubo AK, Serna-Higuita LM, Zuluaga-Valencia G. Disseminated histoplasmosis and haemophagocytic syndrome in two kidney transplant patients. Nefrologia. 2012;32:683-4. http://dx.doi.org/10.3265/Nefrologia.pre2012.Jun.11508.
Lo MM, Mo JQ, Dixon BP, Czech KA. Disseminated histoplasmosis associated with hemophagocytic lympho-histiocytosis in kidney transplant recipients. Am J Transplant. 2010;10:687-91. http://dx.doi.org/10.1111/j.1600-6143.2009.02969.x.
Mehta R, Smith R. Hemophagocytic lymphohistiocytosis (HLH): A review of literature. Med Oncol. 2013;30:740. http://dx.doi.org/10.1007/s12032-013-0740-3.
Zhang L, Zhou J, Sokol L. Hereditary and acquired hemophagocytic lymphohistiocytosis. Cancer Control. 2014; 21:301-12.
Kaito K, Kobayashi M, Katayama T, Otsubo H, Ogasawara Y, Sekita T, et al. Prognostic factors of hemophagocytic syndrome in adults: Analysis of 34 cases. Eur J Haematol. 1997;59:247-53.
Lin TF, Ferlic-Stark LL, Allen CE, Kozinetz CA, Mcclain KL. Rate of decline of ferritin in patients with hemophagocytic lymphohistiocytosis as a prognostic variable for mortality. Pediatr Blood Cancer. 2011;56:154-5. http://dx.doi.org/10.1002/pbc.22774.
