Critically Severe Case of Neonatal Herpes with High Viral Load and Hemophagocytic Syndrome
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- Takehara Hiroki
- Department of Pediatrics, The University of Tokyo Hospital Department of Neonatology, Tokyo Metropolitan Bokutoh Hospital
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- Hirohata Koji
- Department of Pediatrics, The University of Tokyo Hospital Department of Neonatology, Tokyo Metropolitan Bokutoh Hospital
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- Mutoh Hiroshi
- Department of Pediatrics, The University of Tokyo Hospital
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- Irisa Chiharu
- Department of Pediatrics, The University of Tokyo Hospital
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- Kakiuchi Satsuki
- Department of Pediatrics, The University of Tokyo Hospital
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- Nishimura Riki
- Department of Pediatrics, The University of Tokyo Hospital
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- Oka Akira
- Department of Pediatrics, The University of Tokyo Hospital
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- Takahashi Naoto
- Department of Pediatrics, The University of Tokyo Hospital
抄録
<p>Neonatal disseminated herpes simplex virus (HSV) infection is a severe disease with high mortality and morbidity; yet, the pathophysiology remains unclear. Here, we report a male infant with disseminated HSV type 1 (HSV-1) infection, complicated by hemophagocytic lymphohistiocytosis (HLH) and multiple organ failure. The infant, born at 39 weeks of gestation by normal delivery, developed fever (38.5˚C) with the high serum C-reactive protein levels on the 1st day of life, and exhibited tachypnea on the 3rd day. On the 5th day of life, the patient received mechanical ventilation and was transferred to our neonatal ICU. Real-time PCR for HSV-1 DNA revealed an extremely high serum concentration (1.0 × 109 copies/µL), and he was diagnosed with HSV-1 infection. Acyclovir (ACV) and corticosteroid pulse therapies with methylprednisolone were started. Continuous hemodiafiltration (CHDF) using cytokine-absorbing hemofilters was also initiated because of renal failure. These therapies, however, failed to control the disease, and the patient died on the 41st day of life. The dose of ACV on CHDF might not be adequate, although we could not measure the serum ACV concentrations. After the patient’s death, we measured his serum cytokine concentrations taken four times during the clinical course. Serum concentrations of interleukin (IL)-6, IL-10, IL-1β, and interferon (IFN)-γ were elevated at the time of admission and were remarkably decreased by 10 days after treatment. In particular, the concentrations of IL-1β and IFN-γ were lower than the measurable ranges. It is therefore important to measure serum cytokine concentrations in real time to prevent excessive immune suppression.</p>
収録刊行物
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- The Tohoku Journal of Experimental Medicine
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The Tohoku Journal of Experimental Medicine 247 (3), 149-152, 2019
東北ジャーナル刊行会