BACKGROUND Malaria-associated secondary hemophagocytic lymphohistiocytosis(HLH)is rare.Moreover,the literature on malaria-associated HLH is sparse,and there are no similar cases reported in China.CASE SUMMARY We repor...BACKGROUND Malaria-associated secondary hemophagocytic lymphohistiocytosis(HLH)is rare.Moreover,the literature on malaria-associated HLH is sparse,and there are no similar cases reported in China.CASE SUMMARY We report the case of a 29-year-old woman with unexplained intermittent fever who was admitted to our hospital due to an unclear diagnosis.The patient concealed her history of travel to Nigeria before onset.We made a diagnosis of malaria-associated secondary HLH.The treatment strategy for this patient included treatment of the inciting factor(artemether for 9 d followed by artemisinin for 5 d),the use of immunosuppressants(steroids,intravenous immunoglobulin)and supportive care.The patient was discharged in normal physical condition after 25 d of intensive care.No relapses were documented on follow-up at six months and 1 year.CONCLUSION Early diagnosis of the primary disease along with timely intervention and a multidisciplinary approach can help patients achieve a satisfactory outcome.展开更多
目的:探讨CD8^(+)T细胞功能变化在继发性噬血细胞综合征(sHLH)发病过程中的作用和意义,揭示sHLH可能的发病机制。方法:流式细胞术检测sHLH患者CD8^(+)T细胞耗竭标记PD-1、TIM-3和LAG-3的表达,ΔCD107a表达和细胞内干扰素γ(IFN-γ)分泌...目的:探讨CD8^(+)T细胞功能变化在继发性噬血细胞综合征(sHLH)发病过程中的作用和意义,揭示sHLH可能的发病机制。方法:流式细胞术检测sHLH患者CD8^(+)T细胞耗竭标记PD-1、TIM-3和LAG-3的表达,ΔCD107a表达和细胞内干扰素γ(IFN-γ)分泌水平,检测效应记忆CD8^(+)T细胞、调节性T细胞及双阴性T细胞的数量。结果:sHLH患者CD8^(+)T细胞上抑制性受体PD-1、TIM-3和LAG-3的表达水平分别为40.73±22.64、15.97±14.45和0.73(0-37.41),明显高于对照组的14.48±7.98、1.95±1.52和0.01(0-2),差异均有统计学意义(P<0.001);而CD8^(+)T细胞的ΔCD107a表达量(4.49±2.71 vs 6.07±2.14,P=0.035)和IFN-γ分泌水平(37.30±24.46 vs 55.17±22.23,P=0.034)则明显低于对照组。sHLH患者效应记忆性CD8^(+)T细胞的数量明显少于对照组(14.35±10.37 vs 22.92±11.12,P=0.016),而调节性T细胞及双阴性T细胞数量则无明显差异。sHLH患者活动期CD8^(+)T的PD-1、TIM-3和LAG-3表达量分别为38.09±21.87、14.35±13.70和0.82(0-13.22),明显高于缓解期的24.27±17.23(P=0.03)、8.64±5.60(P=0.014)和0.13(0-3.69)(P=0.043)。结论:CD8^(+)T细胞功能耗竭可能是参与sHLH发生的重要环节之一。展开更多
文摘BACKGROUND Malaria-associated secondary hemophagocytic lymphohistiocytosis(HLH)is rare.Moreover,the literature on malaria-associated HLH is sparse,and there are no similar cases reported in China.CASE SUMMARY We report the case of a 29-year-old woman with unexplained intermittent fever who was admitted to our hospital due to an unclear diagnosis.The patient concealed her history of travel to Nigeria before onset.We made a diagnosis of malaria-associated secondary HLH.The treatment strategy for this patient included treatment of the inciting factor(artemether for 9 d followed by artemisinin for 5 d),the use of immunosuppressants(steroids,intravenous immunoglobulin)and supportive care.The patient was discharged in normal physical condition after 25 d of intensive care.No relapses were documented on follow-up at six months and 1 year.CONCLUSION Early diagnosis of the primary disease along with timely intervention and a multidisciplinary approach can help patients achieve a satisfactory outcome.
文摘目的:探讨CD8^(+)T细胞功能变化在继发性噬血细胞综合征(sHLH)发病过程中的作用和意义,揭示sHLH可能的发病机制。方法:流式细胞术检测sHLH患者CD8^(+)T细胞耗竭标记PD-1、TIM-3和LAG-3的表达,ΔCD107a表达和细胞内干扰素γ(IFN-γ)分泌水平,检测效应记忆CD8^(+)T细胞、调节性T细胞及双阴性T细胞的数量。结果:sHLH患者CD8^(+)T细胞上抑制性受体PD-1、TIM-3和LAG-3的表达水平分别为40.73±22.64、15.97±14.45和0.73(0-37.41),明显高于对照组的14.48±7.98、1.95±1.52和0.01(0-2),差异均有统计学意义(P<0.001);而CD8^(+)T细胞的ΔCD107a表达量(4.49±2.71 vs 6.07±2.14,P=0.035)和IFN-γ分泌水平(37.30±24.46 vs 55.17±22.23,P=0.034)则明显低于对照组。sHLH患者效应记忆性CD8^(+)T细胞的数量明显少于对照组(14.35±10.37 vs 22.92±11.12,P=0.016),而调节性T细胞及双阴性T细胞数量则无明显差异。sHLH患者活动期CD8^(+)T的PD-1、TIM-3和LAG-3表达量分别为38.09±21.87、14.35±13.70和0.82(0-13.22),明显高于缓解期的24.27±17.23(P=0.03)、8.64±5.60(P=0.014)和0.13(0-3.69)(P=0.043)。结论:CD8^(+)T细胞功能耗竭可能是参与sHLH发生的重要环节之一。
