The coexistence of hemophagocytic syndrome and DRESS syndrome that develops in the course of sepsis in an elderly patient in intensive care unit
Öz
Sepsis is one of the leading causes of mortality in intensive care units. Its mortality increases,
especially with the high number of comorbidities and immunosuppression. Hemophagocytic syndrome
is an uncontrolled cytokine storm that develops in the course of increased inflammatory conditions
such as sepsis. The clinical picture is very wide; because of nonspecific symptoms. For this reason; to
diagnose hemophagocytic syndrome, it must be kept in mind. Mortality in hemophagocytic syndrome
is especially high in intensive care patients. Drug reaction with eosinophilia and systemic symptoms
syndrome is a rare, infrequent drug reaction. The clinical picture is heterogeneous and symptoms may
be prolonged despite discontinuation of the drug. Overlap of different diagnoses in elderly patients; In
the presence of multiple drug use and chronic diseases, clinical management is difficult and early
initiation of effective treatment can be delayed. In this case report; a 66-year-old male patient who
underwent nephrostomy due to bilateral hydronephrosis and who developed sepsis and HPS in the
follow-up after hospitalization with high fever and complicated with drug reaction with eosinophilia and
systemic symptoms syndrome during treatment is presented.
Anahtar Kelimeler
Kaynakça
- Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Jama 2016; 315 (8): 775-87.
- Kim HI, Park S. Sepsis: Early Recognition and Optimized Treatment. Tuberc Respir Dis (Seoul) 2019; 82 (1): 6-14.
- Lachmann G, La Rosée P, Schenk T, Brunkhorst FM, Spies C. Hemophagocytic lymphohistiocytosis: A diagnostic challenge on the ICU. Anaesthesist 2016; 65 (10): 776-86.
- Walsh SA, Creamer D. Drug reaction with eosinophilia and systemic symptoms (DRESS): a clinical update and review of current thinking. Clin Exp Dermatol 2011; 36 (1): 6-11.
- Bozkurt D. İç Hastalıklarında İmmün Sistem İlişkili Aciller. 1 Baskı. Ankara: Palme Yayınevi; 2020: 69-80.
- Henter JI, Horne A, Aricó M, et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 2007; 48 (2): 124-31.
- Kardaun SH, Sekula P, Valeyrie-Allanore L, et al. Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study. Br J Dermatol 2013; 169 (5): 1071-80.
Yoğun bakımda yatan yaşlı hastada sepsis seyrinde gelişen hemofagositik sendrom ve DRESS sendromu birlikteliği
Öz
Sepsis, yoğun bakımda mortalitenin önde gelen sebeplerinden birisidir. Sepsis, komorbiditeler ile
immünsupresyon varlığında mortaliteyi geriatrik hastalarda daha da artırmaktadır. Hemofagositik
sendrom, sepsis gibi artmış inflamatuvar durumların seyrinde gelişen kontrolsüz sitokin fırtınasıdır.
Klinik tablo heterojen olduğu için akla gelmedikçe tanı konulması zordur. Bu sendromun mortalitesinin
özellikle yoğun bakım hastasında yüksek olduğu bilinmektedir. DRESS; çok nadir görülen fakat ağır
seyredebilen ilaç reaksiyonudur. Klinik tablo heterojendir ve ilacın kesilmesine rağmen bulgular
uzayabilir. Yaşlı hastalarda farklı tanıların örtüşmesi; çoklu ilaç kullanımı ve kronik hastalıkların da
varlığında klinik yönetimi zorlaştırmakta ve etkin tedavinin erken başlanmasını geciktirmektedir. Bu
olgu sunumunda; bilateral hidronefroz sebebi ile nefrostomi takılan ve ateş yüksekliği sebebiyle ile
servise yatırıldıktan sonra izlemde sepsis, hemofagositik sendrom gelişen ve tedavi sırasında DRESS
sendromu ile komplike olan 66 yaşında erkek hasta sunulmuştur.
Anahtar Kelimeler
Kaynakça
- Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Jama 2016; 315 (8): 775-87.
- Kim HI, Park S. Sepsis: Early Recognition and Optimized Treatment. Tuberc Respir Dis (Seoul) 2019; 82 (1): 6-14.
- Lachmann G, La Rosée P, Schenk T, Brunkhorst FM, Spies C. Hemophagocytic lymphohistiocytosis: A diagnostic challenge on the ICU. Anaesthesist 2016; 65 (10): 776-86.
- Walsh SA, Creamer D. Drug reaction with eosinophilia and systemic symptoms (DRESS): a clinical update and review of current thinking. Clin Exp Dermatol 2011; 36 (1): 6-11.
- Bozkurt D. İç Hastalıklarında İmmün Sistem İlişkili Aciller. 1 Baskı. Ankara: Palme Yayınevi; 2020: 69-80.
- Henter JI, Horne A, Aricó M, et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 2007; 48 (2): 124-31.
- Kardaun SH, Sekula P, Valeyrie-Allanore L, et al. Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study. Br J Dermatol 2013; 169 (5): 1071-80.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 19 Nisan 2021 |
| Gönderilme Tarihi | 18 Ocak 2021 |
| Yayımlandığı Sayı | Yıl 2021 |