VIRUS-ASSOCIATED HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS – THE SEVERE COURSE EXPRESSION IN SARS-COV-2 INFECTION?

M. F. Popa, S. Deacu, L. N. Candea, S. R. Comanici, S. Pricop, L. Mocanu, A. Gheju, D. D. Tabirca

Abstract: The SARS-CoV-2 pandemic has caught the world completely unprepared. Sustained efforts are being made to understand the mechanisms by which this virus acts. One of the oldest and most efficient methods to achieve this is the autopsy, which becomes even more important as their number is limited. We present the case of an 88-year-old man, who died in a car, and was later autopsied at SCJML Constanta. The suspicion of SARS-CoV-2 infection was raised (the man had returned from the most affected area in Romania - Suceava) and the test was performed on a lung fragment taken during the autopsy. The presence of viral pneumonia with diffuse alveolar lesions was found. Lymphohistiocytic hemophagocytosis phenomenon was observed in paratracheal lymph nodes. In SARS-CoV-2 infection, there is the cytokine storm theory, which has multi-organ manifestation. It can occur in severe forms of infection with various viruses (Ebstein-Barr, SARS, MERS) and is the consequence of a hyperactive immune system, especially regarding macrophages. A morphological expression of this aberrant macrophage activation may be lymphohistiocytic hemophagocytosis.
Keywords: COVID19, cytokine storm, lymphohistiocytic hemophagocytosis, SARS-CoV-2, hypercoagulability