HEMOPHAGOCYTOSIS SECONDARY TO PHARYNGEAL ABSCESS IN AN IMMUNOCOMPETENT PATIENT (case report)

• Main Authors: I. D. Khan, M. Malik, K. S. Rajmohan, P. Banerjee, S. Khan, P. S. Panda, M. Brijwal, S. Gupta, K. Kahkasha, S. Gazala, E. Sawarat, M. S. Aguinaga
• Format: Article
• Language: English
• Published: Ukrmedknyha 2018-07-01
• Series: International Journal of Medicine and Medical Research
• Subjects: hemophagocytosis; pharyngeal abscess; Acinetobacter baumanii; pancytopenia; ventilator-associated pneumonia; sepsis.
• Online Access: https://ojs.tdmu.edu.ua/index.php/ijmr/article/view/8514
• ISSN: 2413-6077; 2414-9985

Background. Hemophagocytosis is a rare, potentially fatal disorder, comprising pancytopenia, liver dysfunction, hepatosplenomegaly, hypertriglyceridemia, and hyperferritinemia presenting as fever, lympha­denopathy and skin rashes. Objective. To attract the clinicians’ attention to a problem of hemophagocytosis in Critical Care management. Methods. Hemophagocytosis secondary to pharyngeal abscess in a 58 year old male is being reported. Results. A 58-year-old immunocompetent patient presenting with hemophagocytosis secondary to pharyngeal abscess, was managed on ventilator and inotropic support, when he developed heathcare-associated urinary tract infection by Escherichia coli and ventilator-associated pneumonia by Acinetobacter baumanii. He developed neutropenic septic shock and multi-organ dysfunction and went through a downhill course leading to demise. Conclusions. Hemophagocytosis remains a sinister entity in modern intensive care despite astute clinical management. Secondary superinfections with opportunistic multidrug resistant pathogens are difficult to treat. A high index of clinical suspicion, aggressive diagnosis and prompt treatment for hemophagocytosis and polymicrobial opportunistic superinfections with multidrug-resistant healthcare-associated pathogens needs to be addressed upfront.