Hemophagocytic syndrome: a dilemma chasing the intensivists.
Hemophagocytic lymphohistiocytosis or hemophagocytic syndrome is represented by an uncontrolled inflammatory response characterized by marked histiocyte activation and a cytokine storm. The entity may present a primary or genetic type, and the secondary type is usually triggered by infectious diseases of any kind, autoimmune disease, or neoplasia. This entity, although well described and with definite diagnostic criteria, still remains misdiagnosed because of the overlap presentation with other inflammatory processes. The authors present the case of a 13-year-old girl who was submitted to an appendicectomy complicated with a pericolic abscess, which required a second operation in order to be drained surgically. During the postoperative period of this second surgical procedure, the patient remained febrile, developing cytopenias, and multiple organ failure. Unfortunately, she died despite the efforts of the intensive care staff. The autopsy findings were characteristic of hemophagocytic syndrome. The authors report the case to call attention to this diagnosis whenever unexpected outcomes of infections are experienced.
Pediatrics Department - Hospital das Clínicas - Universidade de São Paulo, São Paulo/SP - Brazil .
Adriana Façanha
AF
Queiroz
Pediatrics Department - Hospital das Clínicas - Universidade de São Paulo, São Paulo/SP - Brazil .
Gabriel Nuncio
GN
Benevides
Pediatrics Division - Intensive Care Unit - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil .
Iracema de Cassia Oliveira Ferreira
Ide C
Fernandes
Pediatrics Division - Intensive Care Unit - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil .
Patricia de Freitas
Pde F
Goes
Pediatrics Division - Intensive Care Unit - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil .
Albert
A
Bousso
Anatomy Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil .
Cristiane Rubia
CR
Ferreira
Appendicectomy; Autopsy; Hemophagocytic Lymphohistiocytosis; Hemophagocytic Syndrome