SARS-CoV-2 Infection-Associated Hemophagocytic Lymphohistiocytosis.

Content Provider	Europe PMC
Author	Prilutskiy, Andrey Kritselis, Michael Shevtsov, Artem Yambayev, Ilyas Vadlamudi, Charitha Zhao, Qing Kataria, Yachana Sarosiek, Shayna R Lerner, Adam Sloan, J Mark Quillen, Karen Burks, Eric J
Copyright Year	2020
Abstract	AbstractObjectivesA subset of coronavirus disease 2019 (COVID-19) patients exhibit clinical features of cytokine storm. However, clinicopathologic features diagnostic of hemophagocytic lymphohistiocytosis (HLH) have not been reported. We studied the reticuloendothelial organs of 4 consecutive patients who died of COVID-19 and correlated with clinical and laboratory parameters to detect HLH.MethodsAutopsies were performed on 4 patients who died of COVID-19. Routine H&E staining and immunohistochemical staining for CD163 were performed to detect hemophagocytosis. Clinical and laboratory results from premortem blood samples were used to calculate H-scores.ResultsAll 4 cases demonstrated diffuse alveolar damage within the lungs. Three of the 4 cases had histologic evidence of hemophagocytosis within pulmonary lymph nodes. One case showed hemophagocytosis in the spleen but none showed hemophagocytosis in liver or bone marrow. Lymphophagocytosis was the predominant form of hemophagocytosis observed. One patient showed diagnostic features of HLH with an H-score of 217, while a second patient likely had HLH with a partial H-score of 145 due to a missing triglyceride level. The remaining 2 patients had H-scores of 131 and 96.ConclusionsThis is the first report of severe acute respiratory syndrome coronavirus 2–associated HLH. Identification of HLH in a subset of patients with severe COVID-19 will inform clinical trials of therapeutic strategies.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC7454285&blobtype=pdf
Page Count	9
ISSN	00029173
Journal	American Journal of Clinical Pathology [Am J Clin Pathol]
Volume Number	154
DOI	10.1093/ajcp/aqaa124
PubMed Central reference number	PMC7454285
Issue Number	4
PubMed reference number	32681166
e-ISSN	19437722
Language	English
Publisher	Oxford University Press
Publisher Date	2020-09-01
Publisher Place	US
Access Restriction	Open
Rights License	This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © American Society for Clinical Pathology, 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
Subject Keyword	SARS-CoV-2 Autopsy Hemophagocytic lymphohistiocytosis HLH Coronavirus Hemophagocytosis 2019-nCoV COVID-19
Content Type	Text
Resource Type	Article
Subject	Pathology and Forensic Medicine