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 Processing time: 146 Days and 16 Hours
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.
