title: Herpes simplex virus 2-associated hemophagocytic lymphohistiocytosis in a pregnant patient.
abstract: 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.
authors.affiliation: Department of Perinatology, National Center for Child Health and Development, Tokyo, Japan. yamaguchi-k@ncchd.go.jp
authors.forename: Koushi
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Akiko
authors.initials: A
authors.lastname: Yamamoto
authors.forename: Michi
authors.initials: M
authors.lastname: Hisano
authors.forename: Michiya
authors.initials: M
authors.lastname: Natori
authors.forename: Atsuko
authors.initials: A
authors.lastname: Murashima
mesh_terms: 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
chemical_list: D000305:Adrenal Cortex Hormones; D016572:Cyclosporine