Chen YY, Xu XZ, Xu XJ. Low interleukin-10 level indicates a good prognosis in Salmonella enterica serovar typhimurium-induced pediatric hemophagocytic lymphohistiocytosis: A case report. World J Clin Cases 2024; 12(9): 1660-1668 [PMID: 38576747 DOI: 10.12998/wjcc.v12.i9.1660]
Corresponding Author of This Article
Xiao-Jun Xu, MD, Chief Doctor, Division/Center of Pediatric Hematology Oncology, Children’s Hospital of Zhejiang University School of Medicine, No. 57 Zhugan Road, Hangzhou 310003, Zhejiang Province, China. xuxiaojun@zju.edu.cn
Research Domain of This Article
Pediatrics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 26, 2024; 12(9): 1660-1668 Published online Mar 26, 2024. doi: 10.12998/wjcc.v12.i9.1660
Low interleukin-10 level indicates a good prognosis in Salmonella enterica serovar typhimurium-induced pediatric hemophagocytic lymphohistiocytosis: A case report
Yuan-Yuan Chen, Xiang-Zhi Xu, Xiao-Jun Xu
Yuan-Yuan Chen, Xiao-Jun Xu, Division/Center of Pediatric Hematology Oncology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Xiang-Zhi Xu, Pediatric Intensive Care Unit, Children’s Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Author contributions: Xu XJ was the principal investigator and takes primary responsibility for the manuscript; Chen YY and Xu XZ acquired and analyzed the data; Chen YY drafted the manuscript; Xu XJ and Chen YY revised the manuscript; All authors approved the final version to be published.
Supported byZhejiang Province Health and Wellness Science and Technology Program in 2022, China, No. 2022RC202.
Informed consent statement: Written informed consent was obtained from the patient’s guardian for publication of this case report and accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Jun Xu, MD, Chief Doctor, Division/Center of Pediatric Hematology Oncology, Children’s Hospital of Zhejiang University School of Medicine, No. 57 Zhugan Road, Hangzhou 310003, Zhejiang Province, China. xuxiaojun@zju.edu.cn
Received: October 30, 2023 Peer-review started: October 30, 2023 First decision: December 29, 2023 Revised: January 10, 2024 Accepted: March 5, 2024 Article in press: March 5, 2024 Published online: March 26, 2024
Abstract
BACKGROUND
Secondary hemophagocytic lymphohistiocytosis (sHLH) triggered by Salmonella enterica serovar Typhimurium is rare in pediatric patients. There is no consensus on how to treat S. typhimurium-triggered sHLH.
CASE SUMMARY
A 9-year-old boy with intermittent fever for 3 d presented to our hospital with positive results for S. typhimurium, human rhinovirus, and Mycoplasma pneumoniae infections. At the time of admission to our institution, the patient’s T helper 1/T helper 2 cytokine levels were 326 pg/mL for interleukin 6 (IL-6), 9.1 pg/mL for IL-10, and 246.7 pg/mL for interferon-gamma (IFN-γ), for which the ratio of IL-10 to IFN-γ was 0.04. In this study, the patient received meropenem, linezolid, and cefoperazone/sulbactam in combination with high-dose methylprednisolone therapy (10 mg/kg/d for 3 d) and antishock supportive treatment twice. After careful evaluation, this patient did not receive HLH chemotherapy and recovered well.
CONCLUSION
S. Typhimurium infection-triggered sHLH patient had a ratio of IL-10 to IFN-γ ≤ 1.33, an IL-10 concentration ≤ 10.0 pg/mL, and/or an IFN-γ concentration ≤ 225 pg/mL at admission. Early antimicrobial and supportive treatment was sufficient, and the HLH-94/2004 protocol was not necessary under these conditions.
Core Tip:Salmonella enterica serovar Typhimurium is one kind of pathogen that can trigger secondary hemophagocytic lymphohistiocytosis (sHLH). There is no consensus on how to treat S. Typhimurium-triggered sHLH. Compared to controls, an S. Typhimurium-triggered sHLH patient showed a ratio of interleukin-10 (IL-10) to interferon-gamma (IFN-γ) ≤ 1.33, an IL-10 concentration ≤ 10.0 pg/mL, and/or IFN-γ concentration ≤ 225 pg/mL on admission. The HLH-94/2004 protocol was not necessary, and early antimicrobial and supportive treatment was sufficient.
