Infect Chemother.  2016 Dec;48(4):338-341. 10.3947/ic.2016.48.4.338.

Severe Fever with Thrombocytopenia Syndrome Presenting with Hemophagocytic Lymphohistiocytosis

• Lee J
• Jeong G
• Lim JH
• Kim H
• Park SW
• Lee WJ
• Jun JB

• KMID: 2441330
• DOI: http://doi.org/10.3947/ic.2016.48.4.338

Abstract

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne disease caused by the newly discovered SFTS Bunyavirus, and there have been no case reports of SFTS patients presenting with hemophagocytic lymphohistiocytosis (HLH) in the English literature. We report a case of SFTS presenting with HLH in a 73-year-old immunocompetent male farmer. Although the patient had poor prognostic factors for SFTS, such as old age and central nervous system symptoms, he recovered fully with supportive care.

Keyword

Severe fever with thrombocytopenia syndrome; Bunyavirus; Hemophagocytic lymphohistiocytosis

MeSH Terms

Aged
Central Nervous System
Farmers
Fever*
Humans
Lymphohistiocytosis, Hemophagocytic*
Male
Orthobunyavirus
Phlebovirus
Thrombocytopenia*
Tick-Borne Diseases

Figure

• 

  Figure 1 The smear of the bone marrow aspiration showed hemophagocytosis of erythroid (arrow) and myeloid precursors (arrowhead) by histiocytes (Wright-Giemsa stain, 1,000×).

• 

  Figure 2 Phylogenetic analysis of the SFTSV KAGBH3 strain (the strain from our patient) based on the partial viral genome sequences (560 bp), which were included in glycoprotein Gn of M segment sequences (A) and nucleocapsid protein of S segment sequences (B). The phylogenetic trees that are shown were generated by MEGA version 5.2 software from aligned nucleotide sequences of 16 isolates of phleboviruses, including the identified SFTSV. Heartland virus was used as the outgroup. The phylogenetic analysis is comparing M and S partial nucleotide sequences of SFTSV KAGBH3 strain with homologous sequences of previously characterized SFTSVs. Sequences were analyzed by the neighbor-joining method based on the maximum composite likelihood model. The minimal length trees shown were supported as the majority rule consensus tree in 5,000 replicates. The bootstrap replicates supporting each node are indicated. KAGBH3 strain is marked with black circles.

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