title: [Transfusion-related acute lung injury during the treatment of EBV-associated hemophagocytic lymphohistiocytosis].
abstract: Transfusion-related acute lung injury (TRALI) is a severe pulmonary complication following blood transfusions. We experienced a case of possible TRALI during the course of EBV-associated hemophagocytic lymphohistiocytosis (EBV-HLH). A 19-year-old woman was admitted to our hospital suffering from fever and abdominal pain. Her laboratory data revealed pancytopenia, liver damage, coagulopathy, and a high titer of EBV-DNA. Computed tomography showed hepatosplenomegaly and bone marrow aspiration revealed hemophagocytosis and the proliferation of atypical lymphocytes. A diagnosis of EBV-HLH was made and plasma exchange was performed. Severe hypoxia due to pulmonary edema developed two hours after starting the plasma transfusion. Methylprednisolone pulse therapy and non-invasive positive pressure ventilation ameliorated her respiratory condition. Anti-HLA class I and II antibodies were detected in donor sera and a cross-match test between patient lymphocytes and donor plasma was positive. To the best of our knowledge, this is the first case report of TRALI complicated with EBV-HLH. It is possible that hypercytokinemia accompanied by HLH was associated with the onset of TRALI.
authors.affiliation: Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University.
authors.forename: Eriko
authors.initials: E
authors.lastname: Nakashima
authors.forename: Motoaki
authors.initials: M
authors.lastname: Shiratsuchi
authors.forename: Emi
authors.initials: E
authors.lastname: Honda
authors.forename: Eriko
authors.initials: E
authors.lastname: Fujioka
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Ohno
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nakashima
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Matsushima
authors.forename: Hiromi
authors.initials: H
authors.lastname: Iwasaki
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Abe
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Takayanagi
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology*; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000175:diagnosis / Q000276:immunology*; D005260:Female; D005334:Fever; D006680:HLA Antigens / Q000097:blood; D006801:Humans; D051359:Lymphohistiocytosis, Hemophagocytic / Q000209:etiology / Q000276:immunology / Q000628:therapy*; D011654:Pulmonary Edema / Q000150:complications; D065227:Transfusion Reaction; D055815:Young Adult
chemical_list: D006680:HLA Antigens