Bowel Perforation During Haemophagocytic Lymphohistiocytosis Treatment with Corticosteroids and Anakinra

Jan Adamski; Björn Jäschke; Tuomas Nieminen; Wojciech Weigl

doi:10.12890/2021_002842

Bowel Perforation During Haemophagocytic Lymphohistiocytosis Treatment with Corticosteroids and Anakinra

Eur J Case Rep Intern Med. 2021 Oct 12;8(10):002759. doi: 10.12890/2021_002842. eCollection 2021.

Authors

Jan Adamski¹, Björn Jäschke², Tuomas Nieminen³, Wojciech Weigl⁴

Affiliations

¹ Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland.
² Department of Anaesthesiology and Intensive Care, Satakunta Central Hospital, Pori, Finland.
³ Department of Infectious Diseases, Satakunta Central Hospital, Pori, Finland.
⁴ Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.

Abstract

We report the use of anakinra to treat a case of a 64-year-old man diagnosed with haemophagocytic lymphohistiocytosis (HLH) with neurological involvement. After the administration of intravenous pulse corticosteroid therapy, immunoglobulin and anakinra the patient showed neurological recovery. However, the recovery was complicated by the perforation of a pre-existing bowel diverticulum. The effect of anakinra on bowel inflammation has not yet been clearly established. It can potentially augment bowel inflammation and contribute to the risk of bowel perforation associated with the concomitant use of corticosteroids.

Learning points: Anakinra can potentially augment bowel inflammation.The concomitant use of anakinra and corticosteroids may increase the risk of bowel perforation.Use of anakinra and corticosteroids in patients with pre-existing gastrointestinal diseases requires vigilant observation for abdominal symptoms.

Keywords: Diverticulitis; gastrointestinal diseases; gut; haemophagocytic lymphohistiocytosis (HLH); interkeukin-1 (IL-1) receptor antagonist.