Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
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Case Report

Volume 13, Number 5, May 2022, pages 207-211

A Case of Delayed COVID-19-Related Macrophage Activation Syndrome


Figure 1.
Figure 1. Chest X-ray: increased air space shadowing (arrows) in the mid and lower zones with a peripheral pattern suggestive of COVID-19 pneumonia. COVID-19: coronavirus disease 2019.
Figure 2.
Figure 2. Chest X-ray: extensive abnormal densities (arrows) throughout the lung fields are consistent with COVID-19 infection. COVID-19: coronavirus disease 2019.
Figure 3.
Figure 3. CT of abdomen and pelvis: multiple pulmonary emboli (arrows). CT: computed tomography.
Figure 4.
Figure 4. CT of chest: pulmonary changes suggestive of evolving COVID-19 pneumonitis with some confluent consolidation in the right base (arrow). CT: computed tomography; COVID-19: coronavirus disease 2019.
Figure 5.
Figure 5. CT of abdomen: diffuse fatty change and perihepatic edema (arrow) are in keeping with acute hepatitis. CT: computed tomography.


Table 1. Patient Results Against Criteria for Hyperinflammatory Syndrome
CriteriaFirst admissionSecond admission
LDH: lactate dehydrogenase; AST: aspartate aminotransferase; ALT: alanine aminotransferase; CRP: C-reactive protein.
Fever (temperature more than 38 °C)39.5 °C38.2 °C
Ferritin concentration (40 - 405 µg/L)1,620> 99,999
Neutrophil count (2.1 - 7.4 × 109/L)12.5511.15
Lymphocytes count (1.0 - 3.6 × 109/L)0.590.45
Platelets count (150 - 400 × 109/L)24065
Quantitative D-dimer (0 - 250 ng/mL)446375
LDH level (135 - 225 U/L)334543
AST level (0 - 40 U/L)Not done23,118
ALT level (0 - 41 U/L)10113,685
CRP level (0 - 5 mg/L)24455
Triglycerides level (less than 1.7 mmol/L)1.31.9