key: cord-0006933-temnlbv9
authors: Asai, Nobuhiro; Ohkuni, Yoshihiro; Matsunuma, Ryo; Iwama, Kanichi; Otsuka, Yoshihito; Kawamura, Yasutaka; Motojima, Shinji; Kaneko, Norihiro
title: Reply to swine flu and hemophagocytic syndrome
date: 2012-06-29
journal: J Infect Chemother
DOI: 10.1007/s10156-012-0443-2
sha: 3eec577d44b59ab31e8a119a7bcc0b3902a80f4b
doc_id: 6933
cord_uid: temnlbv9

nan

To the Editor Dr. Viroj indicated that other infection could not be ruled out in our case [1] . While the patient received erythromycin 1,000 mg/day IV for 5 days, no bacterial pathogens were detected in sputum cultures by bronchoalveolar lavage fluid (BALF). All viral antibody tests such as for parainfluenza, coxsackie, rhinovirus, and RS virus were negative; only that for flu A was positive. We believe that influenza virus (H1N1) pneumonia should be diagnosed with radiologic findings.

Dr. Viroj suggested that there is no proof that virusassociated hemophagocytic syndrome (VAHS) in the cases reported by Beutel [2] is totally caused by swine flu virus induction. Unfortunately, we could not confirm that Beutel et al. ruled out other causes of hemophagocytic syndrome (HPS) in the report. However, we guess that occurrence of HPS triggers a similar cytokine storm similarly in those patients, resulting in severe inflammation such as acute respiratory distress syndrome (ARDS) or systemic inflammatory response syndrome (SIRS) [3] . Thus, bicytopenia or pancytopenia should be monitored. Although previous reports have not demonstrated that influenza virus is a common pathogen causing HPS [4] , we think that HPS could possibly occur in patients with influenza virus (H1N1).

A case of novel swine influenza A (H1N1) pneumonia complicated with virus-associated hemophagocytic syndrome

Virus-associated hemophagocytic syndrome as a major contributor to death in patients with 2009 influenza A (H1N1) infection

Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection

Hemophagocytic syndromes and infection

Acknowledgments We are grateful for the diligent and thorough critical reading of our manuscript by Mr. John Wocher, Executive Vice President and Director, International Affairs/International Patient Services, Kameda Medical Center (Japan).