早期治療が奏功した高齢者のA 型インフルエンザウイルス（H3N2 型）感染症に続発したウイルス関連血球貪食性リンパ組織球症の1 例

• 鈴木 慎太郎

  昭和大学医学部内科学講座呼吸器・アレルギー内科部門 イェテボリ大学クレフティングリサーチセンター

• 田中 明彦

  昭和大学医学部内科学講座呼吸器・アレルギー内科部門

• 福田 陽佑

  昭和大学医学部内科学講座呼吸器・アレルギー内科部門

• 宮田 祐人

  昭和大学医学部内科学講座呼吸器・アレルギー内科部門

• 村田 泰規

  昭和大学医学部内科学講座呼吸器・アレルギー内科部門

• 岸野（大木） 康成

  昭和大学医学部内科学講座呼吸器・アレルギー内科部門

• 本間 哲也

  昭和大学医学部内科学講座呼吸器・アレルギー内科部門

• 大西 司

  昭和大学医学部内科学講座呼吸器・アレルギー内科部門

• 相良 博典

  昭和大学医学部内科学講座呼吸器・アレルギー内科部門

書誌事項

タイトル別名

• Successful Treatment of Seasonal Influenza A (H3N2) infection-related Hemophagocytic Lymphocytosis in an Elderly Man
• 症例 早期治療が奏功した高齢者のA型インフルエンザウイルス(H3N2型)感染症に続発したウイルス関連血球貪食性リンパ組織球症の1例
• ショウレイ ソウキ チリョウ ガ ソウコウ シタ コウレイシャ ノ Aガタ インフルエンザウイルス(H3N2ガタ)カンセンショウ ニ ゾクハツ シタ ウイルス カンレン ケッキュウドンショクセイ リンパ ソシキキュウショウ ノ 1レイ

抄録

A 79-year-old man experienced severe chronic obstructive pulmonary disease (COPD) and was receiving treatment for ischemic heart disease. Starting from dizziness and chilliness, he lost consciousness after few days. He was taken to our emergency department. On initial evaluation, he complained of dyspnea and was afebrile with a pulse rate, blood pressure, and respiratory rate of 105 beats/min, 112/98 mmHg, and 28 breath/min, respectively. His respiratory sounds were clear and chest radiography did not show any abnormal shadows, but his arterial blood gas examination showed type II respiratory failure. Because the nasopharyngeal seasonal influenza A virus (IAV) test was positive, the patient was admitted with the diagnosis of acute exacerbation of COPD due to IAV. We administered peramivir, a specific anti-influenza drug, and started mechanical ventilation. Over time, he started to show signs of disseminated intravascular coagulation, such as multiple organ failure and thrombocytopenia. Subsequently, blood tests showed elevation of ferritin and soluble interleukin 2 receptor (sIL2R)；microscopic examination of the peripheral blood revealed hemophagocytosis. Secondary hemophagocytic lymphohistiocytosis (HLH) due to IAV was diagnosed and together with corticosteroid therapy, intravenous gamma globulin was administered from the 3^rd clinical day. The patint was saved with our early diagnosis and treatment of HLH and was discharged on the 92^nd clinical day. Viral-induced HLH, formerly known as virus-associated hemophagocytic syndrome (VAHS), leads to multiple organ failure due to a cytokine storm scattered by viral-infected pathogenic inflammatory cells. It is well known that pandemic swine flu causes secondary HLH leading to poor outcomes. Currently, not much is known about HLH due to seasonal flu；particularly, IAV (H3N2)-related HLH cases are rare and reported cases showed poor outcomes as well. With an early diagnosis and minimum immunotherapy, we report herein on a case of IAV (H3N2)-related HLH which was treated successfully.

収録刊行物

• 感染症学雑誌

  感染症学雑誌 90 (1), 77-82, 2016

  一般社団法人 日本感染症学会

キーワード

• seasonal influenza
• hemophagocytic lymphohistiocytosis
• cytokine storm

詳細情報

• CRID: 1390282680024470144
• NII論文ID: 130005982864
• NII書誌ID: AN00047715
• DOI: 10.11150/kansenshogakuzasshi.90.77
• ISSN: 1884569X
• ISSN: 03875911
• NDL書誌ID: 027085300
• Web Site: https://ndlsearch.ndl.go.jp/books/R000000004-I027085300
• Web Site: https://www.jstage.jst.go.jp/article/kansenshogakuzasshi/90/1/90_77/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2016310728
• 本文言語コード: ja
• データソース種別:
  • JaLC
  • NDL
  • Crossref
  • CiNii Articles
• 抄録ライセンスフラグ: 使用不可