Low interleukin-10 level indicates a good prognosis in Salmonella enterica serovar typhimurium-induced pediatric hemophagocytic lymphohistiocytosis: A case report

doi:10.12998/wjcc.v12.i9.1660

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World Journal of Clinical Cases

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Case Report

World J Clin Cases. Mar 26, 2024; 12(9): 1660-1668
Published online Mar 26, 2024. doi: 10.12998/wjcc.v12.i9.1660

Low interleukin-10 level indicates a good prognosis in Salmonella enterica serovar typhimurium-induced pediatric hemophagocytic lymphohistiocytosis: A case report

Yuan-Yuan Chen, Xiang-Zhi Xu, Xiao-Jun Xu

Yuan-Yuan Chen, Xiao-Jun Xu, Division/Center of Pediatric Hematology Oncology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China

Xiang-Zhi Xu, Pediatric Intensive Care Unit, Children’s Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China

Author contributions: Xu XJ was the principal investigator and takes primary responsibility for the manuscript; Chen YY and Xu XZ acquired and analyzed the data; Chen YY drafted the manuscript; Xu XJ and Chen YY revised the manuscript; All authors approved the final version to be published.

Supported by Zhejiang Province Health and Wellness Science and Technology Program in 2022, China, No. 2022RC202.

Informed consent statement: Written informed consent was obtained from the patient’s guardian for publication of this case report and accompanying images.

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Xiao-Jun Xu, MD, Chief Doctor, Division/Center of Pediatric Hematology Oncology, Children’s Hospital of Zhejiang University School of Medicine, No. 57 Zhugan Road, Hangzhou 310003, Zhejiang Province, China. xuxiaojun@zju.edu.cn

Received: October 30, 2023
Peer-review started: October 30, 2023
First decision: December 29, 2023
Revised: January 10, 2024
Accepted: March 5, 2024
Article in press: March 5, 2024
Published online: March 26, 2024
Processing time: 146 Days and 16 Hours

Abstract

BACKGROUND

Secondary hemophagocytic lymphohistiocytosis (sHLH) triggered by Salmonella enterica serovar Typhimurium is rare in pediatric patients. There is no consensus on how to treat S. typhimurium-triggered sHLH.

CASE SUMMARY

A 9-year-old boy with intermittent fever for 3 d presented to our hospital with positive results for S. typhimurium, human rhinovirus, and Mycoplasma pneumoniae infections. At the time of admission to our institution, the patient’s T helper 1/T helper 2 cytokine levels were 326 pg/mL for interleukin 6 (IL-6), 9.1 pg/mL for IL-10, and 246.7 pg/mL for interferon-gamma (IFN-γ), for which the ratio of IL-10 to IFN-γ was 0.04. In this study, the patient received meropenem, linezolid, and cefoperazone/sulbactam in combination with high-dose methylprednisolone therapy (10 mg/kg/d for 3 d) and antishock supportive treatment twice. After careful evaluation, this patient did not receive HLH chemotherapy and recovered well.

CONCLUSION

S. Typhimurium infection-triggered sHLH patient had a ratio of IL-10 to IFN-γ ≤ 1.33, an IL-10 concentration ≤ 10.0 pg/mL, and/or an IFN-γ concentration ≤ 225 pg/mL at admission. Early antimicrobial and supportive treatment was sufficient, and the HLH-94/2004 protocol was not necessary under these conditions.

Keywords: Hemophagocytic lymphohistiocytosis; Cytokine pattern; Interferon gamma; Interleukin-10; Salmonella enterica serovar Typhimurium; Case report

Core Tip:Salmonella enterica serovar Typhimurium is one kind of pathogen that can trigger secondary hemophagocytic lymphohistiocytosis (sHLH). There is no consensus on how to treat S. Typhimurium-triggered sHLH. Compared to controls, an S. Typhimurium-triggered sHLH patient showed a ratio of interleukin-10 (IL-10) to interferon-gamma (IFN-γ) ≤ 1.33, an IL-10 concentration ≤ 10.0 pg/mL, and/or IFN-γ concentration ≤ 225 pg/mL on admission. The HLH-94/2004 protocol was not necessary, and early antimicrobial and supportive treatment was sufficient.