Hemophagocytic syndrome after recovery from SARS-Cov-2 infection: a Case Report

Abstract Background Hemophagocytic syndrome (HPS) or hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory disease, whose diagnosis is based on the HLH-2004 criteria. In secondary forms of HLH (sHLH), the primary goal is treating the triggering factors such as SARS-CoV-2-19 infection. The link between the cytokine storm related to SARS-CoV-2-19infection and development of sHLH has already been reported since the onset of pandemic (1), but little is known about clinical manifestations of HLH which develop after patient’s recovery from SARS-CoV-2-19 infection. Case presentation A 56-year-old caucasian female was diagnosed with sHLH according to HLH-2004 criteria, after recovery from a mild symptomatic SARS-CoV-2-19 infection and received immunosuppressive treatment (high-dose steroids, IVIG, low dose Ruxolitinib and Etoposide. Antiviral (acyclovir), antibiotic (sulfamethoxazole / trimethoprim) and heparin prophylaxes were administered. Colchicine therapy was added considering the pericarditis. Improvement in patient symptoms and normalization of blood count as well as fibrinogen and ferritin values was observed.Conclusion Our report suggests that HLH-like syndrome might be secondary to SARS CoV-2-19 infection, even after the patient completely recovered from the mildly symptomatic viral infection. In addition, we underline the treatment with low dose ruxolitinib plus etoposide as a potential choice for SARS-CoV-2-19 related HLH.