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Pregnancy-Induced Hemophagocytic Lymphohistiocytosis: A Case Report

  • Luis A. Sánchez-AtoEmail author
  • Flavia A. Cuestas-Quiroz
  • Carla Agurto-Saldaña
  • David Estela-Ayamamani
Case Report
  • 5 Downloads

Case Report

We present a 23-year-old pregnant woman gravida 3, para 1 27 weeks of gestation complaining of intermittent fever, hyporexia, and vomiting since one week. She had history of malar rash that increased with sun exposure since adolescence. Physical examination revealed fever, pulse of 99 beats per min, blood pressure of 80/50 mmHg, and breathing frequency of 19/min. She was pale, a maculopapular skin rash over both cheeks was observed. There was no lymphadenopathy or joint pain. The liver was palpable 2 cm below the right costal margin and tender; the spleen was not palpable. The uterus was gravid, normal tone, fetal heart rate was 158 beats per min, fetal movement was present, and uterine height was 23 cm. She was awake, oriented, and responsive. Laboratory results showed a hemoglobin of 11.1 g/dL, leukocytes of 6220/mm3, a platelet count of 240,000/mm3, and C protein reactive of 13.3 mg/L, urinary sediment showed leukocyturia without nitrites.

There was a suspicion of...

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study is exempted from ethical approval by ethics committee of Hospital Nacional Edgardo Rebagliati Martins.

Research Involving Human Participants and/or Animals

This article does not contain any studies with animals performed by any of the authors.

References

  1. 1.
    Henter J-I, Horne A, Aricó M, Egeler RM, Filipovich AH, Imashuku S, et al. HLH-2004: diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. J Clin Oncol. 2007;27(1):4169.Google Scholar
  2. 2.
    Larroche C. Hemophagocytic lymphohistiocytosis in adults: diagnosis and treatment. Jt Bone Spine. 2012;79(4):356–61.CrossRefGoogle Scholar
  3. 3.
    Henter J, Elinder G, Soder O, Ost AKE. Incidence in Sweden and clinical features of familial hemophagocytic lymphohistiocytosis. Acta Pizdiatr Scand. 1991;80(2):428–35.CrossRefGoogle Scholar
  4. 4.
    Esumi N, Imashuku S. Hyperferritinemia in malignant histiocytosis, virus-associated hemophagocytic syndrome and familial erythrophagocytic lymphohistiocytosis. Acta Paediatr Scand. 1989;5:268–70.CrossRefGoogle Scholar
  5. 5.
    Bergsten E, Horne AC, Aricó M, Astigarraga I, Egeler RM, Filipovich AH, et al. Confirmed efficacy of etoposide and dexamethasone in HLH treatment: long-term results of the cooperative HLH-2004 study. Blood. 2017;130(25):2728–38.CrossRefGoogle Scholar
  6. 6.
    Niece JA, Rogers ZR, Ahmad N, Langevin A-M, MaClain KL. Hemophagocytic lymphohistiocytosis in texas: observations on ethnicity and race. J Clin Oncol [Internet]. 2010;27(1):4169.Google Scholar
  7. 7.
    Trottestam H, Horne AC, Aricò M, Egeler RM, Filipovich AH, Gadner H, et al. Chemoimmunotherapy for hemophagocytic lymphohistiocytosis: long-term results of the HLH-94 treatment protocol. Blood. 2011;118(17):4577–84.CrossRefGoogle Scholar
  8. 8.
    Ferreri AJM, Dognini GP, Campo E, Willemze R, Seymour JF, Bairey O, et al. Variations in clinical presentation, frequency of hemophagocytosis and clinical behavior of intravascular lymphoma diagnosed in different geographical regions. Haematologica. 2007;92(4):486–92.CrossRefGoogle Scholar
  9. 9.
    Henter J, Elinder G. Haemophagocytic lymphohistiocytosis: an inherited primary form and a reactive secondary form. Br J Haematol. 1995;91:774–5.CrossRefGoogle Scholar
  10. 10.
    Clementi R, Emmi L, Maccario R, Liotta F, Moretta L, Danesino C, et al. Adult onset and atypical presentation of hemophagocytic lymphohistiocytosis in siblings carrying PRF1 mutations. Blood. 2002;100(6):2266–7.CrossRefGoogle Scholar
  11. 11.
    Henter JI, Aricò M, Elinder G, Imashuku S, Janka G. Familial hemophagocytic lymphohistiocytosis. Primary hemophagocytic lymphohistiocytosis. Hematol Oncol Clin North Am. 1998;12(2):417–33.CrossRefGoogle Scholar
  12. 12.
    Janka GE. Familial hemophagocytic lymphohistiocytosis. Eur J Pediatr. 1983;140(3):221–30.CrossRefGoogle Scholar
  13. 13.
    Jayawardena L, McNamara E. Diagnosis and management of pregnancies complicated by Haemolysis, Elevated Liver Enzymes and Low Platelets (HELLP) syndrome in the tertiary setting. Intern Med J. 2019.  https://doi.org/10.1111/imj.14337.CrossRefPubMedGoogle Scholar
  14. 14.
    Herath RP, Siriwardana SR, Ekanayake CD, Abeysekara V, Kodithuwakku SUA, Herath HP. Non-alcoholic fatty liver disease and pregnancy complications among Sri Lankan women: a cross sectional analytical study. PLoS ONE. 2019;14(4):1–15.CrossRefGoogle Scholar
  15. 15.
    van Kester MS, Langeveld TJC, Bouwsma H, van Rees JB, Holman ER, Teng YKO, et al. A breathtaking DRESS due to amoxicillin–clavulanate presenting as polymorphic eruption of the pregnancy. J Eur Acad Dermatol Venereol. 2018;32(12):e436–7.CrossRefGoogle Scholar
  16. 16.
    He M, Jia J, Zhang J, Beejadhursing R, Mwamaka Sharifu L, Yu J, et al. Pregnancy-associated hemophagocytic lymphohistiocytosis secondary to NK/T cells lymphoma. Medicine (United States). 2017;96(47):e8628.Google Scholar
  17. 17.
    Shukla A, Kaur A, Hira HS. Pregnancy induced haemophagocytic syndrome. J Obstet Gynecol India. 2013;63(3):203–5.CrossRefGoogle Scholar
  18. 18.
    Sarkissian S, Khan Y, Farrell D, Constable D, Brem E. Hemophagocytic lymphohistiocytosis in the setting of HELLP syndrome. Clin Case Rep. 2018;6(12):2466–70.CrossRefGoogle Scholar
  19. 19.
    Uzan J, Carbonnel M, Piconne O, Asmar R, Ayoubi JM. Pre-eclampsia: pathophysiology, diagnosis, and management. Vasc Health Risk Manag. 2011;7(1):467–74.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Williams Z, Zepf D, Longtine J, Anchan R, Broadman B, Missmer SA, et al. Foreign fetal cells persist in the maternal circulation. Fertil Steril. 2009;91(6):2593–5.CrossRefGoogle Scholar

Copyright information

© Federation of Obstetric & Gynecological Societies of India 2019

Authors and Affiliations

  1. 1.Escuela de Medicina, Facultad de Ciencias de la SaludUniversidad Peruana de Ciencias Aplicadas (UPC)LimaPeru
  2. 2.Departamento de Obstetricia y GinecologíaHospital Nacional Edgardo Rebagliati MartinsLimaPeru

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