Infect Chemother.  2016 Dec;48(4):330-333. 10.3947/ic.2016.48.4.330.

Epstein-Barr Virus Associated Hemophagocytic Syndrome after Scrub Typhus Infection

• Hong JW
• You HS
• Lee TW
• Jo WY
• Kim BR
• Suh YS
• Bae IG
• Cho OH

• KMID: 2441328
• DOI: http://doi.org/10.3947/ic.2016.48.4.330

Abstract

There have been a small number of cases of scrub typhus-associated hemophagocytic syndrome (HPS), most of which were treated successfully using adequate antibiotics. Here, we report a case of Epstein-Barr virus (EBV)-associated HPS after scrub typhus infection that was not improved using antirickettsial treatment. A 73-year-old male who had been diagnosed with scrub typhus according to an eschar and a positive serology was transferred to our institution because of a persistent fever despite 7-day doxycycline therapy. Physical and laboratory data showed hepatosplenomegaly, bicytopenia, hyperferritinemia, and hypofibrinogenemia. A bone marrow examination (BM) revealed hypercellular marrow with hemophagocytosis and histiocyte infiltration. EBV was detected in BM aspirates using polymerase chain reaction. After a diagnosis of HPS was made, the patient was treated successfully using high-dose steroids.

Keyword

Epstein-Barr virus infections; Lymphohistiocytosis, Hemophagocytic; Scrub typhus

MeSH Terms

Aged
Anti-Bacterial Agents
Bone Marrow
Bone Marrow Examination
Diagnosis
Doxycycline
Epstein-Barr Virus Infections
Fever
Herpesvirus 4, Human*
Histiocytes
Humans
Lymphohistiocytosis, Hemophagocytic*
Male
Polymerase Chain Reaction
Scrub Typhus*
Steroids
Anti-Bacterial Agents
Doxycycline
Steroids

Figure

• 

  Figure 1 Microscopic finding of bone marrow aspiration shows hemophagocytosis of neutrophils, normoblasts, and platelets (Wright-Giemsa stain, ×1,000)

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