TY - JOUR
T1 - Hemophagocytic lymphohistiocytic syndrome
T2 - Unrecognized cause of multiple organ failure
AU - Nahum, Elhanan
AU - Ben-Ari, Josef
AU - Stain, Jeremiya
AU - Tommy, Schonfeld
PY - 2000/7
Y1 - 2000/7
N2 - Objective:To describe an often-unrecognized clinical picture of multiple organ failure in hemophagocytic lymphohistiocytic syndrome (HLS). Design:Retrospective chart review. Setting:A ten-bed pediatric intensive care unit (PICU) in a tertiary children's university hospital. Patients:A total of 11 children (age, 5 months to 13 yrs) who fulfilled the criteria for the diagnosis of familial- or infectious-associated hemophagocytic lymphohistiocytosis and who required intensive care support for organ failure. Intervention:None. Main Results:During a 10-yr period, 5,439 children were hospitalized in our PICU. A total of 11 children were diagnosed as suffering with HLS. Of these 11 patients, three (27%) had the familial form and eight had the infectious-associated form. After admission to the PICU, seven patients (63%) were diagnosed as suffering with HLS and each had one or more organ failures (patients 3-7, 9, and 10). All presented with fever, hepatomegaly, and splenomegaly; in addition, all had at least two of the following: anemia, neutropenia, or thrombocytopenia. All 11 had lymphohistiocytic accumulation in bone marrow (n 10), lymph node (n 2), lung (n 2), and/or liver (n 1). Organ failure was noted most often in the respiratory system (n 7) attributable to severe, acute respiratory distress syndrome and pleural effusion. Of the 11 patients, six had cardiovascular involvement that manifested as shock in three and as capillary leak syndrome in three. Renal failure occurred in four patients. Of these, two required hemodiafiltration and one required peritoneal dialysis. Liver failure occurred in three and central nervous system involvement and coma in three. Most of the patients required massive therapeutic intervention, including assisted ventilation (n 6), inotropic support (n 3), and hemofiltration (n 3). A total of seven patients (63%) died. Conclusions:Hemophagocytic lymphohistiocytic syndrome in the pediatric population may have a dramatic clinical picture, with multiple organ failure as a presenting symptom or early in the disease course, mandating intensive support in the PICU.
AB - Objective:To describe an often-unrecognized clinical picture of multiple organ failure in hemophagocytic lymphohistiocytic syndrome (HLS). Design:Retrospective chart review. Setting:A ten-bed pediatric intensive care unit (PICU) in a tertiary children's university hospital. Patients:A total of 11 children (age, 5 months to 13 yrs) who fulfilled the criteria for the diagnosis of familial- or infectious-associated hemophagocytic lymphohistiocytosis and who required intensive care support for organ failure. Intervention:None. Main Results:During a 10-yr period, 5,439 children were hospitalized in our PICU. A total of 11 children were diagnosed as suffering with HLS. Of these 11 patients, three (27%) had the familial form and eight had the infectious-associated form. After admission to the PICU, seven patients (63%) were diagnosed as suffering with HLS and each had one or more organ failures (patients 3-7, 9, and 10). All presented with fever, hepatomegaly, and splenomegaly; in addition, all had at least two of the following: anemia, neutropenia, or thrombocytopenia. All 11 had lymphohistiocytic accumulation in bone marrow (n 10), lymph node (n 2), lung (n 2), and/or liver (n 1). Organ failure was noted most often in the respiratory system (n 7) attributable to severe, acute respiratory distress syndrome and pleural effusion. Of the 11 patients, six had cardiovascular involvement that manifested as shock in three and as capillary leak syndrome in three. Renal failure occurred in four patients. Of these, two required hemodiafiltration and one required peritoneal dialysis. Liver failure occurred in three and central nervous system involvement and coma in three. Most of the patients required massive therapeutic intervention, including assisted ventilation (n 6), inotropic support (n 3), and hemofiltration (n 3). A total of seven patients (63%) died. Conclusions:Hemophagocytic lymphohistiocytic syndrome in the pediatric population may have a dramatic clinical picture, with multiple organ failure as a presenting symptom or early in the disease course, mandating intensive support in the PICU.
KW - acute respiratory distress syndrome
KW - capillary leak
KW - children
KW - familial hemophagocytic lymphohistiocytic syndrome
KW - infectious-associated hemophagocytosis
KW - liver failure
KW - organ failure
KW - pediatric
KW - renal failure
KW - shock
UR - http://www.scopus.com/inward/record.url?scp=84992261246&partnerID=8YFLogxK
U2 - 10.1097/00130478-200007000-00010
DO - 10.1097/00130478-200007000-00010
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AN - SCOPUS:84992261246
SN - 1529-7535
VL - 1
SP - 51
EP - 54
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 1
ER -