COVID-19 gone bad: A new character in the spectrum of the hyperferritinemic syndrome?

Autoimmun Rev. 2020 Jul;19(7):102573. doi: 10.1016/j.autrev.2020.102573. Epub 2020 May 5.


The severe form of COVID-19 share several clinical and laboratory features with four entities gathered under the term "hyperferritinemic syndromes" and including macrophage activation syndrome (MAS), adult-onset Still's disease (AOSD), catastrophic anti-phospholipid syndrome (CAPS) and septic shock. COVID-19 systemic inflammatory reaction and "hyperferritinemic syndromes" are all characterized by high serum ferritin and a life-threatening hyper-inflammation sustained by a cytokines storm which eventually leads to multi-organ failure. In this review, we analyze the possible epidemiological and molecular mechanisms responsible for hyper-inflammation in patients with severe COVID-19 and we underline the similarities between this condition and "hyperferritinemic syndromes" which would allow considering severe COVID-19 as a fifth member of this spectrum of inflammatory conditions.

Keywords: COVID-19; Cytokine storm; Ferritin; Inflammation.

Publication types

  • Review

MeSH terms

  • Antiphospholipid Syndrome
  • Betacoronavirus
  • Blood Coagulation Disorders
  • COVID-19
  • Coronavirus Infections / physiopathology*
  • Cytokine Release Syndrome / immunology
  • Cytokine Release Syndrome / virology
  • Ferritins
  • Humans
  • Inflammation
  • Macrophage Activation Syndrome
  • Pandemics
  • Pneumonia, Viral / physiopathology*
  • SARS-CoV-2
  • Shock, Septic
  • Still's Disease, Adult-Onset


  • Ferritins