title: Hemophagocytic lymphohistiocytosis in a rheumatoid arthritis patient treated with infliximab.
abstract: Hemophagocytic lymphohistiocytosis (HLH) is a rare condition with high mortality. We report a case of a 74-year-old woman with rheumatoid arthritis who developed HLH secondary to pyelonephritis due to Escherichia coli infection following infliximab treatment. Bone marrow aspiration showed proliferation of histiocytes with hemophagocytosis. The patient died despite treatment with intravenous antibiotics intravenous methylprednisolone and intravenous immunoglobulin. Cytokine levels were measured and are discussed.
authors.affiliation: Division of Hematology, Clinical Immunology and Nephrology, Matsue Red Cross Hospital, Japan. hematology@matsue.jrc.or.jp
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Oda
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Urushidani
authors.forename: Shinji
authors.initials: S
authors.lastname: Ooi
authors.forename: Akira
authors.initials: A
authors.lastname: Endoh
authors.forename: Rika
authors.initials: R
authors.lastname: Nakamura
authors.forename: Koji
authors.initials: K
authors.lastname: Adachi
authors.forename: Hiroko
authors.initials: H
authors.lastname: Fukushima
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D001853:Bone Marrow / Q000473:pathology; D004927:Escherichia coli Infections / Q000150:complications* / Q000188:drug therapy; D017809:Fatal Outcome; D005260:Female; D006644:Histiocytes / Q000473:pathology; D006801:Humans; D016867:Immunocompromised Host; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000069285:Infliximab; D051359:Lymphohistiocytosis, Hemophagocytic / Q000209:etiology*; D000077731:Meropenem; D008775:Methylprednisolone / Q000627:therapeutic use; D011704:Pyelonephritis / Q000150:complications* / Q000188:drug therapy; D013845:Thienamycins / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D013845:Thienamycins; D000069285:Infliximab; D000077731:Meropenem; D008775:Methylprednisolone