P89 | Macrophage activation syndrome secondary to salmonellosis

E. Maccolini, E. Elia, A. Neri, D. Marini, C.E. Lizzio, L. Andreetto, L. Diotalevi, A. Trentini, M.C. Potenza, M. Migliori | Medicina Interna Migliori IRCCS Sant’Orsola, Bologna, Italy

Premises: Macrophage activation syndrome (MAS) is a potentially life-threatening condition belonging to the histiocytoses, characterized by abnormal activation of the macrophage system and T lymphocytes, resulting in a cytokine and inflammatory storm capable of causing rapidly progressive generalized systemic damage. Diagnostic delay is an important negative prognostic factor.
Case study: We report a case of MAS secondary to group E salmonellosis in a 29-year-old patient admitted for persistent fever, which started after a trip to Thailand, initially without associated organ symptoms. Biochemical tests revealed mild leukopenia and thrombocytopenia, increased liver cytolysis markers, hypertriglyceridemia, and hyperferritinemia. The clinical picture rapidly deteriorated, leading to the development of multi-organ failure (MOF) requiring treatment in an intensive care setting. After the diagnosis was confirmed, the patient was treated with methylprednisolone 1 mg/kg/day, with an excellent clinical response.
Conclusions: MAS can be secondary to other diseases belonging to various specialist fields. The diagnosis is difficult, typically requiring the exclusion of other causes. One of the biggest dangers is diagnostic delay, which can lead to catastrophic consequences, even death, in patients without comorbidities and in excellent general condition. In the presence of suggestive clinical and laboratory findings, MAS should be considered early in the differential diagnosis.