Herpes simplex virus 2-associated hemophagocytic lymphohistiocytosis in a pregnant patient.
BACKGROUND
Uncontrolled phagocytosis of normal hemopoietic cells by activated histiocytes in bone marrow is collectively referred to as hemophagocytic lymphohistiocytosis.


METHODS
We present a case of hemophagocytic lymphohistiocytosis associated with herpes simplex virus-2 infection in the second trimester. Cytopenia, elevated C-reactive protein, ferritin, soluble interleukin-2 receptor, and interleukin-6 with high-grade fever were observed following genital herpes infection, and the existence of hemophagocytes in bone marrow confirmed the diagnosis of hemophagocytic lymphohistiocytosis. Corticosteroid therapy failed to arrest the hemophagocytic process, whereas cyclosporin A was effective. The patient delivered a healthy infant after remission and has not experienced exacerbation.


CONCLUSIONS
It is often important to take into consideration hemophagocytic lymphohistiocytosis when encountering cytopenia with high-grade fever. Cyclosporin A was a safe and available strategy for this corticosteroid-resistant case.
Yamaguchi
Koushi
K
Department of Perinatology, National Center for Child Health and Development, Tokyo, Japan. yamaguchi-k@ncchd.go.jp
Yamamoto
Akiko
A
Hisano
Michi
M
Natori
Michiya
M
Murashima
Atsuko
A
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001774:Blood Chemical Analysis; D001854:Bone Marrow Cells; D002585:Cesarean Section; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006561:Herpes Simplex / Q000175:diagnosis* / Q000188:drug therapy; D018258:Herpesvirus 2, Human / Q000302:isolation & purification*; D015616:Histiocytosis, Non-Langerhans-Cell / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D010298:Parity; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis* / Q000188:drug therapy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D018570:Risk Assessment; D012720:Severity of Illness Index
D000305:Adrenal Cortex Hormones; D016572:Cyclosporine