Hemophagocytic syndrome occurred after severe sepsis in a hemodialysis patient: An autopsy case report

Abstract

A 75-year-old male who underwent hemodialysis developed progressive anemia and thrombocytopenia, and hyperferritinemia despite being symptomless. He was admitted to our hospital because of intradialytic hypotension. The patient's laboratory data showed aggravated thrombocytopenia and hyperferritinemia together with high levels of C-reactive protein and procalcitonin. Cultures of the patient's blood and bone marrow aspirate confirmed the presence of methicillin-resistant Staphylococcus aureus. A bone marrow biopsy was performed, which demonstrated signs of the phagocytosis of blood components. Based on these findings, we diagnosed the patient with hemophagocytic syndrome (HPS). Intensive care, including steroid pulse therapy and continuous hemodiafiltration, had no effect, and the patient died of multiple organ failure. The autopsy demonstrated hemophagocytosis in the patient's bone marrow and severe purulent cystitis. In this case, the HPS initially exhibited a mild course, but then became rapidly progressive following the development of severe sepsis.The adequate diagnosis and treatment of infection-related HPS before it progresses to sepsis or the patient's general condition deteriorates are necessary to ensure the survival of hemodialysis patients.