title: [28-year old female patient with respiratory insufficiency, elevated liver enzymes, pancytopenia and fever].
abstract: We report on a 28-year old female patient with fever and severe respiratory insufficiency requiring mechanical ventilation. Cytomegalovirus pneumonia was diagnosed by bronchoalveolar lavage, and antiviral therapy was initiated. However fever persisted and laboratory workup showed pancytopenia and elevated liver enzymes. Additional blood tests demonstrated a markedly elevated ferritin level and high concentrations of inflammatory cytokines. A diagnosis of hemophagocytic lymphohistiocytosis was made and immunosuppressive therapy was started. The patient's condition and laboratory values improved rapidly.
authors.affiliation: II. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg. wolschke@uke.de
authors.forename: Ch
authors.initials: Ch
authors.lastname: Wolschke
authors.forename: W
authors.initials: W
authors.lastname: Fiedler
authors.forename: R C
authors.initials: RC
authors.lastname: Habermann
authors.forename: G E
authors.initials: GE
authors.lastname: Janka-Schaub
authors.forename: S
authors.initials: S
authors.lastname: Kluge
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001856:Bone Marrow Examination; D016572:Cyclosporine / Q000627:therapeutic use; D016207:Cytokines / Q000097:blood; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D005293:Ferritins / Q000097:blood*; D005335:Fever of Unknown Origin / Q000209:etiology*; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008111:Liver Function Tests; D051359:Lymphohistiocytosis, Hemophagocytic / Q000175:diagnosis* / Q000188:drug therapy; D010198:Pancytopenia / Q000209:etiology*; D011024:Pneumonia, Viral / Q000175:diagnosis* / Q000188:drug therapy; D011241:Prednisone / Q000627:therapeutic use; D012131:Respiratory Insufficiency / Q000209:etiology*; D014057:Tomography, X-Ray Computed
chemical_list: D000998:Antiviral Agents; D016207:Cytokines; D007166:Immunosuppressive Agents; D005047:Etoposide; D016572:Cyclosporine; D005293:Ferritins; D015774:Ganciclovir; D011241:Prednisone