title: Clinical features of haemophagocytic syndrome in patients with systemic autoimmune diseases: analysis of 30 cases.
abstract: OBJECTIVE
  Haemophagocytic syndrome (HPS) is known as a relatively rare complication in autoimmune diseases. Here we analysed the clinical features of HPS in patients with systemic autoimmune diseases.
  
  
  METHODS
  One thousand and fourteen patients with systemic autoimmune diseases admitted to Hokkaido University Hospital from 1997 to 2007 were recruited [350 SLE, 136 RA, 98 polymyositis/dermatomyositis (PM/DM), 88 SSc, 91 vasculitis syndrome, 37 primary SS, 26 adult onset Still's disease (AOSD) and 188 other diseases]. Clinical features and treatment outcomes were retrospectively analysed.
  
  
  RESULTS
  Thirty cases (3.0%) fulfilled HPS criteria (progressive cytopenia in two or more lineages and haemophagocytosis in reticuloendothelial systems). Underlying diseases were SLE (18), RA (2), PM/DM (2), SSc (2), vasculitis (1), SS (2) and AOSD (3). Nineteen patients were diagnosed as having autoimmune-associated HPS, eight infection-associated, one drug-induced and one developed HPS after haematopoietic stem cell transplantation. For the treatment of HPS, high-dose corticosteroid monotherapy was given in 26 cases, being effective in 12 (46%). Ten out of 15 patients with corticosteroid-resistant autoimmune-associated HPS were treated with CsA, cyclophosphamide or tacrolimus, leading to the remission in 80%. The overall mortality rate was 20%. Multivariate analysis showed that the presence of infections and CRP level >50 mg/l on HPS related with poor prognosis.
  
  
  CONCLUSIONS
  The prevalence of HPS among in-hospital patients with systemic autoimmunity is not ignorable. Administration of immunosuppressants was effective in cases with autoimmune-associated HPS, whereas prognosis was poor in infection-associated HPS.
authors.affiliation: Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Fukaya
authors.forename: S
authors.initials: S
authors.lastname: Yasuda
authors.forename: T
authors.initials: T
authors.lastname: Hashimoto
authors.forename: K
authors.initials: K
authors.lastname: Oku
authors.forename: H
authors.initials: H
authors.lastname: Kataoka
authors.forename: T
authors.initials: T
authors.lastname: Horita
authors.forename: T
authors.initials: T
authors.lastname: Atsumi
authors.forename: T
authors.initials: T
authors.lastname: Koike
mesh_terms: D000328:Adult; D000368:Aged; D001327:Autoimmune Diseases / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D003520:Cyclophosphamide / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use; D014777:Virus Diseases / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003520:Cyclophosphamide; D016559:Tacrolimus