PARVOVIRUS B19 ASSOCIATED HEMOPHAGOCYTIC LENFOHYSTIOCYOCYOSIS IN A TWENTY-SIX WEEKS PREGNANT

Öz

Hemophagocytic lymphohistiocytosis (HLH) is an inflammatory disease that is typically a complication of infection (viral / bacterial), malignancy, or rheumatologic disease in adults. Hemophagocytic syndrome associated with viral infection (most commonly Epstein-Barr Virus [EBV], human immunodeficiency virus [HIV], cytomegalovirus [CMV] and rarely caused by Parvovirus B19. Parvovirus B19 associated HLH was first reported in 1979, and it has a less mortal prognosis than others. It is thought that Parvovirus B19 does not cause fetal malformations when acquired in early pregnancy. However, Parvovirus B19 infections during pregnancy can cause fetal heart failure and fetal death secondary to severe fetal anemia caused by the destruction of erythropoietic stem cells by the virus. In primary Parvovirus B19, the risk of fetal damage is estimated to be relatively low (1-2%) and the risk of long-term sequelae appears to be even lower. In this case report, it was aimed to present the presence of HLH originating from Parvovirus B19 in a 26-week pregnant woman.

Anahtar Kelimeler

• Hemophagocytic lymphohistiocytosis
• Parvovirus B19
• pregnant

YİRMİALTI HAFTALIK GEBEDE PARVOVİRUS B19 KAYNAKLI HEMOFAGOSİTİK LENFOHİSTİYOSİTOZ

Öz

Hemofagositik lenfohistiyositoz (HLH), yetişkinlerde tipik olarak enfeksiyon (viral/bakteriyal), malignite veya romatolojik hastalığın bir komplikasyonu olan enflamatuar bir hastalıktır. Viral enfeksiyon ilişkili (en sık Epstein-Barr Virüsü [EBV], insan immün yetmezlik virüsü [HIV], sitomegalovirüs [CMV] ve nadiren de Parvovirus B19 kaynaklı HLH gelişebilir. Parvovirus B19 kaynaklı HLH ilk kez 1979’da bildirilmiş olup, diğerlerine göre daha az mortal seyirlidir. Parvovirus B19’un, hamileliğin erken döneminde edinildiğinde fetal malformasyonlara neden olmadığı düşünülmektedir. Bununla birlikte, hamilelik sırasında Parvovirus B19 enfeksiyonları, virüs tarafından eritropoietik kök hücrelerin tahrip edilmesi sonucunda ortaya çıkan ciddi fetal anemiye sekonder gelişen fetal kalp yetmezliği ve fetal ölüme neden olabilir. Birincil Parvovirus B19 'da fetal hasar riskinin nispeten düşük olduğu tahmin edilmektedir (% 1-2) ve uzun vadeli sekel riski daha da düşük görünmektedir. Bu vaka sunumunda 26 haftalık gebede Parvovirus B19 kaynaklı HLH varlığı sunulmak istenmiştir.

Anahtar Kelimeler

• Hemofagositik lenfohistiyositoz
• Parvovirus B19
• gebe

Kaynakça

1. 1. Ozgen B, Karli-Oguz K, Tavil B, et al. Diffusion-weighted cranial MR. Imaging findings in a patient with hemophagocytic syndrome AJNR 2006; 27(6):1312-14.
2. 2. Eraslan C, Aydın E, Maharramova E, et al. Hemofagositik lenfohistiyositoz hastalarında kraniyal MRG bulguları. ETD 2018; 57(1): 14-8.
3. 3. Filipovich AH. Hemophagocytic lymphohistiocytosis (HLH) and related disorders. Hematology Am Soc Hematol Educ Program 2009:127-31.
4. 4. Kalmuk J, Matar S, Feng G, et al. Parvovirus B19-induced hemophagocytic lymphohistiocytosis: Case report and review of the literature. Clin Case Rep 2019;7(11):2076-81. 5. Cossart YE, Field AM, Cant B, Widdows D. Parvovirus-like particles in human sera. Lancet 1975;1(7898):72-3.
5. 6. Ornoy A, Ergaz Z. Parvovirus B19 infection during pregnancy and risks to the fetus. Birth Defects Res. 2017;109(5):311-23.
6. 7. Lundqvist A, Tolfvenstam T, Bostic J, et al. Clinical and laboratory findings in immunocompetent patients with persistent parvovirus B19 DNA in bone marrow. Scand J Infect Dis 1999;31(1):11‐6.
7. 8. Henter J‐I, Horne A, Aricó M, et al. HLH‐2004: diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer. 2007;48(2):124‐31.
8. 9. Fardet L, Galicier L, Lambotte O, et al. Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome. Arthritis Rheumatol 2014;66(9):2613‐20.

9. 10. Henter J‐I,Samuelsson‐Horne A, Aricò M, et al. Treatment of hemophagocytic lymphohistiocytosis with HLH‐94 immunochemotherapy and bone marrow transplantation. Blood 2002;100(7):2367‐73.