Haemophagocytic lymphohistiocytosis associated with bartonella peliosis hepatis following kidney transplantation in a patient with HIV.
Haemophagocytic lymphohistiocytosis associated with bartonella peliosis hepatis following kidney transplantation in a patient with HIV.
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HIV 患者肾移植后与肝紫癜性巴尔通体相关的噬血细胞淋巴组织细胞增多症。
DOI：
10.1016/s1473-3099(22)00276-6
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发表时间：
2022-10
影响因子：
56.3
通讯作者：
Woodworth, Michael H.
中科院分区：
文献类型：
--
作者：
Steed, Danielle;Collins, Jeffrey;Farris, Alton B.;Guarner, Jeannette;Yarar, Dilek;Friedman-Moraco, Rachel;Doane, Tristan;Pouch, Stephanie;Lyon, G. Marshall, III;Woodworth, Michael H.
杆菌性肝炎是一种公认的表现，传播巴尔通体感染，可发生在免疫功能低下的个人。噬血细胞性淋巴组织细胞增生症（HLH）是一种免疫介导的疾病，其特征可与严重的原发性感染（如播散性巴尔通体感染）重叠。我们报告一位人类免疫缺陷病毒（HIV）感染控制良好的肾移植受者，由于播散性巴尔通体感染而发生杆菌性紫癜性肝炎和继发性HLH。病人有两个星期的发烧和腹痛，并发现有肝肿大。他回忆起与一只病狗的接触，但没有回忆起与猫的接触。实验室评价中值得注意的是全血细胞减少和胆汁淤积性损伤。该患者符合HLH的8项临床标准中的5项以上。骨髓芯活检的病理学审查确定为噬血细胞增多症。进行了经颈静脉肝活检，组织病理学检查发现了肝炎。骨髓Warthin-Starry染色显示多形球杆菌。巴尔通体IgG滴度为1：512，外周血PCR检测到巴尔通体特异性DNA靶标。多西环素治疗，增加泼尼松，并保持他的移植免疫抑制方案中的霉酚酸酯成分，导致了良好的临床反应。继发性HLH可能难以与严重的全身感染区分。高度怀疑可支持HLH患者系统性巴尔通体感染的诊断，尤其是伴有肝肿大、免疫抑制和密切动物接触的患者。作者介绍了一名患者的情况下，噬血细胞淋巴组织细胞增多症（HLH）与巴尔通体紫癜性肝炎在肾移植受者与控制良好的艾滋病毒感染。巴尔通体和HLH的临床表现，诊断和管理进行了审查。巴尔通体感染引起的HLH和紫癜性肝炎的特征可能有助于医务人员识别发热、腹痛和肝肿大患者的这些情况。
Bacillary peliosis hepatis is a well-recognized manifestation of disseminated Bartonella infection that can occur in immunocompromised individuals. Hemophagocytic lymphohistiocytosis (HLH) is an immune-mediated condition with features that can overlap with a severe primary infection such as disseminated Bartonella infection. We report a case of bacillary peliosis hepatis and secondary HLH due to disseminated Bartonella infection in a kidney transplant recipient with well-controlled human immunodeficiency virus (HIV) infection. The patient had two weeks of fever and abdominal pain and was found to have hepatomegaly. He recalled exposure to a sick dog but had no recalled cat exposures. Laboratory evaluation was notable for pancytopenia and cholestatic injury. This patient met greater than five of eight clinical criteria for HLH. Pathology review of a bone marrow core biopsy identified hemophagocytosis. A transjugular liver biopsy was performed, and histopathology review identified peliosis hepatis. Warthin-Starry staining of the bone marrow showed pleiomorphic coccobacillary organisms. The Bartonella IgG titer was 1:512 and Bartonella-specific DNA targets were detected by peripheral blood PCR. Treatment with doxycycline, increased prednisone, and holding the mycophenolate component of his transplant immunosuppression regimen resulted in an excellent clinical response. Secondary HLH can be difficult to distinguish from severe systemic infection. A high index of suspicion can support the diagnosis of systemic Bartonella infection in those who present with HLH, especially in patients with hepatomegaly, immunosuppression, and germane animal exposures. The authors present the case of a patient with hemophagocytic lymphohistiocytosis (HLH) associated with Bartonella peliosis hepatis in a renal transplant recipient with well-controlled HIV infection. The clinical presentation, diagnostic, and management of Bartonella and HLH are reviewed. Features of HLH and peliosis hepatis due to Bartonella infection may help providers recognize these conditions in patients with fever, abdominal pain, and hepatomegaly.