Hemophagocytic syndrome: a review of 18 pediatric cases

J Microbiol Immunol Infect. 2004 Jun;37(3):157-63.


This retrospective study included 18 pediatric cases (median age, 3 years) with pathologically proved hemophagocytic syndrome (HPS) from a single institution during 1992 and 2001. There were 9 males and 9 females. Prolonged fever, cytopenia, liver dysfunction and hepatomegaly were the most common features at presentation. Sixteen (88.9%) cases were previously healthy. The case fatality rate was 61.1%, and all fatal cases died within 2 months of disease onset. The infectious agents associated with HPS were identified in 11 cases (61.1%), and 8 (72.7%) of them had evidence of Epstein-Barr virus (EBV) infection or reactivation. Underlying immunologic disorder or neoplastic disease was identified in 11.1% of the cases. Children less than 3 years of age with HPS were more vulnerable to neutropenia-associated bloodstream infection (85.7% vs 27.3%; p=0.025). Pseudomonas aeruginosa (3) and Candida tropicalis (2) were the 2 most commonly isolated pathogens. Regarding specific management of HPS, intravenous immunoglobulin and steroids were the first-line agents and were administered in 16 cases and 11 cases, respectively, while etoposide was administered in 5 refractory cases during the late phase of disease. Most HPS occurred in previously healthy children, and a substantial proportion of cases rapidly progressed to death. Most cases were associated with viral infection, particularly EBV, and young children tended to develop neutropenia-associated bacteremia during the active phase of the disease.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Epstein-Barr Virus Infections / complications
  • Female
  • Herpesvirus 4, Human / isolation & purification
  • Histiocytosis, Non-Langerhans-Cell* / mortality
  • Histiocytosis, Non-Langerhans-Cell* / physiopathology
  • Histiocytosis, Non-Langerhans-Cell* / therapy
  • Humans
  • Infant
  • Infections / complications
  • Infections / microbiology
  • Infections / virology
  • Male
  • Retrospective Studies
  • Treatment Outcome