COVID-19 and the hyperferritinemic syndromes

The hyperferritinemic syndromes include macrophage activation syndrome, adult onset Still's disease, catastrophic antiphospholipid syndrome, and septic shock. The syndrome is characterized by life-threatening disease due to the development of a cytokine storm, multiorgan damage, elevated ferritin levels, and the response to similar therapies. In the third phase of SARS-COV2 infection, the hyperinflammatory phase, elevated ferritin levels and the development of a cytokine storm are present. A new entity, multisystem inflammatory syndrome, described predominantly in pediatric patients, mimics MAS, yet develops without a previous symptomatic disease. In these patients, hyperferritinemia is prominent. Elevated ferritin levels in COVID-19 intensive care unit patients predict mortality. Ferritin levels in nonsurvivors are much higher than those who survive. Consecutive measurements of a rising ferritin level may predict the need for assisted ventilation. Treatments such as corticosteroids, biologics, and IVIG may also be beneficial for COVID-19 as they are for the other hyperferritinemic syndromes. In this review, we present proof of concept for COVID-19 to be included with the other entities in the hyperferritinemic syndrome.