Hemophagocytic lymphohistiocytosis and congenital factor VII deficiency: a case report

BMC Med Genet. 2018 Sep 12;19(1):163. doi: 10.1186/s12881-018-0673-y.

Abstract

Background: Hemophagocytic lymfohistiocytosis (HLH) is a rare, life-threatening hyperinflammation, characterized by immune system over-activation resulting in hemophagocytosis. HLH could appear as a primary disease caused by mutations of immune-regulatory genes, or develop as a result of viral or bacterial infections, or malignancy. Congenital factor VII (FVII) deficiency is a rare autosomal recessive disorder characterized by prolonged prothrombin time (PT) and low FVII, which may increase bleeding risk.

Case presentation: A 50-year-old woman was admitted for a fever persisted for 20 days, presenting with cytopenia, high hyperferritinemia, low activity of NK cells. Bone marrow aspiration showed hemophagocytosis. CT scanning found pulmonary infection. EBV and CMV were not detected. Genetic scanning did not find pathogenic mutation of a HLH NGS panel including 26 genes. This patient was treated as recommended by the HLH 2004 Guidelines. Coagulation tests identified FVII deficiency. Genetic analysis of F7 gene in the patient and her family members identified recurrent compound heterozygous F7 c.64 + 5G > A and c.1224 T > G (p.His408Gln) mutations in this patient and her brother who showed postoperative hemorrhage after surgical resection of renal cell carcinoma. Heterozygotes in this family were asymptomatic.

Conclusions: To our knowledge, this is the first report of HLH in combination with congenital FVII deficiency in Chinese population.

Keywords: Factor VII deficiency; Hemophagocytic lymfohistiocytosis; Hemophagocytosis; Infection.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Asian People
  • Base Sequence
  • DNA Mutational Analysis
  • Factor VII / genetics*
  • Factor VII Deficiency / congenital
  • Factor VII Deficiency / ethnology
  • Factor VII Deficiency / genetics*
  • Factor VII Deficiency / pathology
  • Female
  • Gene Expression
  • Heterozygote
  • Humans
  • Lymphohistiocytosis, Hemophagocytic / ethnology
  • Lymphohistiocytosis, Hemophagocytic / genetics*
  • Lymphohistiocytosis, Hemophagocytic / pathology
  • Male
  • Middle Aged
  • Mutation*
  • Pedigree

Substances

  • Factor VII