SESSION TITLE: Sepsis & Septic Shock Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM
PURPOSE: To describe the specific clinical characteristics, management, and outcome of secondary; HIV/AIDS associated HLH, in adult patients who presented to our medical intensive care unit with septic shock and multiple system organ dysfunction (MOD); and to review the related literature.
METHODS: We report four cases of secondary; HIV/AIDS associated HLH, in adult patients who presented with septic shock and MOD. We performed a retrospective review of medical records at our center to identify patients with HLH from January 2003 to October 2013. The search included all HLH patients with HIV/AIDS who were admitted to the ICU with septic shock and/or MOD features who fulfilled the 2004-HLH diagnostic criteria.
RESULTS: Among our four patients three had disseminated histoplasmosis as a precipitating factor, and the fourth had unclear etiology. We report successful outcomes in two AIDS patients with disseminated histoplasmois-associated HLH. In those two patients HLH was diagnosed and treated earlier (diagnosed and treated on day 2). Observed predictors of poor outcome are: older age, atypical presentation, unknown precipitating factor, very high ferritin level, delayed diagnosis, sever liver damage, and renal failure required Dialysis. We demonstrate that highly suspicious of HLH in HIV/AIDS patients presented with shock and MOD, leads to early diagnosis, early treatment and better outcome.
CONCLUSIONS: Clinicians should increase their awareness of HLH syndrome and the significant overlap with septic shock. Consideration of HLH in an AIDS patient with septic shock and MOD, may lead to improved mortality if detected early. Early specific treatment of the precipitating factor could produce meaningful survival. In AIDS patient with HLH, disseminated histoplasmosis should be considered and treated as early as possible (especially in an endemic area).
CLINICAL IMPLICATIONS: We recommend considering treatment for HLH as early as possible in patients with the following clinical syndrome: unexplained and unremitting sever sepsis and/or septic shock with persistent bycytopenia or pancytopenia, highly elevated ferritin levels and histiocytic hemophagocytosis on bone marrow aspiration (BMA). Treatment strategies for HLH responsible for MOD in HIV/AIDS patients are not well described, but aggressive supportive care combined with specific treatment of the precipitating factor could produce meaningful survival of nearly half the patients. Corticosteroids or other immunomodulators have shown mixed and conflicting results.
DISCLOSURE: The following authors have nothing to disclose: Bassam Yaghmour, Muthiah Muthiah, Ivan Romero-Legro, George Yaghmour, Amado X Freire
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