AUTHOR=Sun Li , Li Pulin , Pang Bo , Wu Peipei , Wang Ran 

TITLE=Gestational Psittacosis With Secondary Hemophagocytic Syndrome: A Case Report and Literature Review

JOURNAL=Frontiers in Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.755669

DOI=10.3389/fmed.2021.755669

ISSN=2296-858X

ABSTRACT=Gestational psittacosis and hemophagocytic syndrome are diseases rarely encountered in the clinic. This article presents a case of gestational psittacosis with secondary hemophagocytic syndrome. The clinical characteristics, signs, laboratory findings, and progression, diagnosis, and treatment of a patient with gestational psittacosis with secondary hemophagocytic syndrome were analyzed, and the literature addressing this disease was reviewed. The patient was definitively diagnosed using metagenomic next-generation sequencing techniques, bone marrow puncture and smear examination, and determination of sCD25 level and natural killer (NK) cell activity. Doxycycline and other anti-infectives, and etoposide combined with hormone chemotherapy, resulted in significant improvement of cough and expectoration, return to normal temperature, and significant improvement in oxygenation index. In addition, chest computed tomography revealed obvious absorption of lung lesions, and NK cell activity and sCD25 levels returned to normal ranges. Chlamydia psittaci pneumonia requires a clear determination of etiology, while hemophagocytic syndrome requires bone marrow puncture and smear examination, combined with determination of sCD25 level and NK cell activity in the blood. Findings of the present study suggest that metagenomic next-generation sequencing is an important tool in clearly identifying pathogens that cause lung infection. Clinicians should consider atypical pathogens of lung infection in patients with poor response to empirical anti-infectives, and strive for clear diagnosis based on etiology to design an effective treatment strategy. For patients experiencing long-term high fever and poor temperature control after broad-spectrum antibiotic treatment, non-infectious fever should be considered. A rapid and clear diagnosis will significantly improve patient prognosis.