Macrophage Activation Syndrome Discovered During Pregnancy: Case Report

Macrophage activation syndrome (MAS) or Haemophagocytic syndrome (HPS) results from an inappropriate stimulation of macrophages in bone marrow and lymphoid organs, leading to haemophagocytosis and hypercytokinemia. HPS may be primitive, essentially in pediatric population, or secondary to malignancy, infection or autoimmune disease. This disease is rare and prognosis is poor. The diagnosis of hemophagocytic syndrome remains a challenge especially during pregnancy. We report a case collected at the Elharouchimaternity service, taken in charge jointly with its intensive care unit, of a 26-year-old patient with no pathological history leading to an unsuccessful pregnancy presumed at 5 months in whom the MAS syndrome was retained due to pancytopenia. , hyperferitinemia, hypertriglyceridemia with the presence of a few hemophagocytes in the myelogram with a good evolution under bolus of solumedrol and symptomatic treatment. We discuss through this case the diagnostic difficulties, the obstetric complications as well as the options therapeutic.

Compromised liver function in patients with a new coronavirus infection COVID-19

Clinicians have noted an increase in the level of hepatic transaminase in patients with the new coronavirus infection COVID-19 a number of times, and an unambiguous answer to the question of what caused this change in laboratory indices has not been received yet. The course of COVID-19 is often complicated by the development of haemophagocytic syndrome, and preventive anti-inflammatory therapy is required for its treatment, which is represented by biologic drugs (interleukin-6 inhibitors or JAK-kinase blockers) and glucocorticosteroids. It has been noted that the level of ALT and AST increases against the background of biological therapy.The objective of the present study was to analyze the possible effect of biological therapy on the functional state of the liver.Material and methods. The study randomly included 38 patients diagnosed with ICD-10 U07.1 (18 women and 20 men). Inclusion criteria were control of aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin at least three times during the period of hospitalization, as well as an increase in these indicators above the reference values. This study was carried out while prescribing preventive anti-inflammatory therapy.Results. The median (Me ± SD) age of the patients was 57 ± 14.67. Mann–Whitney U-test showed no significant difference in the activity of liver enzymes and total bilirubin upon admission to the infectious diseases hospital (p> 0.05). A statistically significant difference in indicators evaluation at admission and at discharge was determined using the Wilcoxon test for ALT levels in the group receiving biologic drugs (p = 0.004). In other cases, there was no statistically significant difference (p > 0.05). When analyzing the level of enzymes for the entire period of hospitalization with the use of Friedman criterion, the level of changes in hepatic transaminases in the group with the use of biologic drugs turned out to be equal for ALT p = 0.001. When assessing changes over the entire period of hospitalization by the de Ritis coefficient, the p-value was also significant (0.001) in this group.Conclusion. This study shows the necessity to control the level of hepatic transaminase, especially when prescribing biological therapy for haemophagocytic syndrome.

Why does activated partial thromboplastin time prolongation occur in severe fever with thrombocytopenia syndrome?

Severe fever with thrombocytopenia syndrome (SFTS) is caused by infection with SFTS virus and this mortality rate is 16.2% to 30%. An 85-year-old male patient presented to the emergency department of the hospital with primary complaints of fever and consciousness disturbance. Haemophagocytic syndrome and prolonged activated partial thromboplastin time (APTT) without associated prolonged prothrombin time were observed, suggesting SFTS, which was eventually diagnosed. APTT-only prolongation has been reported previously with SFTS, but the mechanism is unknown. The absence of coagulation factors was determined by a cross-mixing study. In addition, examination of intrinsic coagulation factors showed reduced factor XI activity. These results suggest that factor XI is causally related to APTT-only prolongation in SFTS.