Viral-associated hemophagocytosis in a patient with severe fever with thrombocytopenia syndrome
演題番号 : OS-3-182
石堂 亜希 （Aki Ishido):1、高橋 徹 （Toru Takahashi):1、重岡 徹 （Toru Shigeoka):1、富永 貴元 （Takayuki Tominaga):1、亀井 敏昭 （Toshiaki Kamei):2、前田 健 （Ken Maeda):3、水谷 哲也 （Tetsuya Mizutani):4、下島 昌幸 （Masayuki Shimozima):5、福士 秀悦 （Shuetsu Fukushi):5、谷 英樹 （Hideki Tani):5、吉河 智城 （Tomoki Yoshikawa):5、森川 茂 （Shigeru Morikawa):6、中島 典子 （Noriko Nakajima):7、鈴木 忠樹 （Tadaki Suzuki):7、永田 典代 （Noriyo Nagata):7、長谷川 秀樹 （Hideki Hasegawa):7、山岸 拓也 （Takuya Yamagishi):8、大石 和徳 （Kazunori Oishi):8、西條 政幸 （Masayuki Saijo):5
1:Department of Hematology, Yamaguchi Grand Medical Center, Japan、2:Department of Pathology, Yamaguchi Grand Medical Center, Japan、3:Department of Veterinary Microbiology, Yamaguchi University, Japan、4:Faculty of Agriculture, Tokyo University of Agriculture and Technology, Japan、5:Department of Virology I, National Institute of Infectious Diseases, Japan、6:Department of Veterinary Science, National Institute of Infectious Diseases, Japan、7:Department of Pathology, National Institute of Infectious Diseases, Japan、8:Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Japan
Severe fever with thrombocytopenia syndrome (SFTS) is a newly discovered tick-borne disease found in China and caused by a novel virus, SFTS virus (SFTSV), classified into the family Bunyaviridae. Patients with SFTS have been reported in Japan, but the pathophysiology is still unclear.
A 50-year-old woman, who lived in the countryside in Japan, experienced high fever and melena in November. Bicytopenia were observed at neighborhood clinic and she was referred to our hospital for a detailed examination. Tick bite wounds were not observed on admission. On peripheral blood counts, Hb was normal, platelets 89,000/μL, and WBC 400/μL. Laboratory test revealed ALT to be 340 U/L, AST 706 U/L, LDH 1232 U/L, and CRP 0.03 mg/dl. Serum ferritin level was increased to >40,000 ng/mL. CT scan showed right axillary lymphadenopathy; however, there was no evidence of hepatosplenomegaly. Bone marrow aspiration revealed a mild hypocellular marrow with increased levels of activated histiocytes and hemophagocytes. The patient died six days after the onset with developed bicytopenia. Autopsy revealed axillary lymphadenitis and severe hemophagocytosis (HS) in the bone marrow. SFTSV was isolated from the serum and SFTSV genome was also detected by PCR assay. Immunohistochemistry assay revealed SFTSV-infected cells in the lymphnode and bone marrow. Because of the definitive diagnosis of SFTSV infection, the HS is recognized as a viral-associated HS.
Cytopenia is a typical finding in SFTS. HS might be contributed to cytopenia in patients with SFTSV-infection.