• Sebastian Schnaubelt, Daniel Tihanyi, Robert Strassl, Ralf Schmidt, Sonja Anders, Anton N Laggner, Hermine Agis, and Hans Domanovits.
• Department of Emergency Medicine, Medical University of Vienna.
• Medicine (Baltimore). 2021 Mar 26; 100 (12): e25170e25170.

RationaleThe immunologic syndrome induced by severe acute coronavirus disease 2019 (COVID-19) is yet not fully understood. Typical patterns of clinical and laboratory features match secondary hemophagocytic lymphohistiocytosis (sHLH). However, the optimal approach to COVID-19 patients testing positive for sHLH is still unclear.Patient ConcernsThree patients with COVID-19 are reviewed. All showed hyperinflammation and cytokine storm, necessitating intensive care treatment including mechanical ventilation.DiagnosisSecondary hemophagocytic lymphohistiocytosis due to severe COVID-19; diagnosed via HScore.InterventionsA treatment regimen of methylprednisolone, pentaglobin, and anakinra was developed and administered.OutcomesOne patient survived the ICU stay. Two other patients, in whom sHLH was diagnosed too late, deceased.LessonsA routine screening of COVID-19 patients for secondary HLH by using the HScore is feasible; especially those patients deteriorating clinically with no sufficient response to shock management might be at particular high risk. A stepwise therapeutic approach comprising corticosteroids, immunoglobulins and anakinra, accompanied by immunoadsorption, may dampen cytokine storm effects, and potentially reduce mortality.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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