title: Hyperferritinemic Sepsis: An Opportunity for Earlier Diagnosis and Intervention?
abstract: We describe a case of an infant with HSV meningitis and septic shock who demonstrated a remarkably high serum ferritin level. Aggressive pediatric intensive care and the administration of high-dose glucocorticoids were not able to reverse the multiple organ dysfunctions. Subsequent autopsy identified the presence of hemophagocytosis, thus the patient fulfilled hemophagocytic lymphohistiocytosis (HLH) criteria post-mortem. This case highlights that serum ferritin may be an important early indicator of mortality in sepsis due to a cytokine storm similar to macrophage activation syndrome and HLH.
authors.affiliation: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Pennsylvania State University College of Medicine , Hershey, PA , USA.
authors.forename: E Scott
authors.initials: ES
authors.lastname: Halstead
authors.affiliation: Pediatric Critical Care Medicine, Helen DeVos Children's Hospital , Grand Rapids, MI , USA.
authors.forename: Surender
authors.initials: S
authors.lastname: Rajasekaran
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA , USA.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Fitzgerald
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA , USA.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Weiss
keywords: HSV; cytokine storm; ferritin; hemophagocytic lymphohistiocytosis; macrophage activation syndrome; sepsis