MEASLES-ASSOCIATED CYTOKINE STORM IN A CHILD: A CASE REPORT

Tóm tắt

Objectives: Cytokine storm (CS) represents a dysregulated hyperinflammatory state that can lead to multiorgan dysfunction. Prompt recognition is crucial in reducing morbidity and mortality.A 13-year-old previously healthy, unvaccinated boy presented with 8 days of high-grade fever, conjunctivitis, maculopapular rash, hoarseness, epigastric pain, and arthralgia. On admission, the patient had tachypnea, hypotension, hepatomegaly, and oliguria. Laboratory results showed thrombocytopenia, hypoalbuminemia, and markedly elevated CRP, procalcitonin, ferritin (> 5,000 ng/mL), AST (640 U/L), ALT (843 U/L), and D-dimer (> 20,000 ng/mL). Cytokine profiling revealed elevated IL-6 (622 pg/mL), IL-18 (122.4 pg/mL), and TNF-α (347 pg/mL). Flow cytometry demonstrated reduced CD3⁺ and CD4⁺ T-cell counts and a low CD4/CD8 ratio. RT-PCR confirmed the presence of the measles virus (MeV) with a cycle threshold of 22, while all other microbiological tests and cultures returned negative. The patient was diagnosed with a measles-associated CS and treated with supportive care, broad-spectrum antibiotics, and intravenous immunoglobulin (IVIG) of 0.4 g/kg/day for 3 days. His fever subsided within 48 hours, and he was discharged in stable condition on day 7. Early identification of CS through cytokine and immunologic profiling is crucial for initiating timely immunomodulatory therapy.