[Hemophagocytic syndrome in two elderly men]

Area of Science:

• Hematology
• Immunology
• Pathology

Background:

• Virus-associated hemophagocytic syndrome (VAHS) is a rare, life-threatening condition characterized by excessive immune activation.
• VAHS can present with diverse clinical manifestations and carries a high mortality rate, particularly in elderly individuals.

Observation:

• Two elderly male patients presented with critical conditions: massive intestinal bleeding and loss of consciousness.
• Neither patient had detectable prodromic infections prior to admission.
• Autopsies revealed significant phagocytosis of red blood cells (RBCs) and white blood cells (WBCs) by histiocytes in key organs (spleen and bone marrow).

Findings:

• The autopsy findings led to the diagnosis of virus-associated hemophagocytic syndrome in both cases.
• The absence of detectable infections suggests non-infectious triggers or an atypical presentation.
• The advanced age of both patients points towards potential underlying immunologic derangements contributing to VAHS development.

Implications:

• This case study highlights the potential for VAHS in elderly individuals, even without apparent infections.
• It underscores the importance of considering VAHS in the differential diagnosis of unexplained bleeding or neurological decline in the elderly.
• Further research into age-related immune dysregulation may elucidate specific risk factors and therapeutic targets for VAHS.