Virus-associated
hemophagocytic syndrome (VAHS) is associated with a systemic
viral infection and is mainly observed in immunosuppressed adult patients. This
rare disease is characterized by symptoms which include a high
fever,
pancytopenia, and
splenomegaly and sometimes results in a fatal outcome. However, thus far, little has been reported on VAHS in general surgical patients. We herein report this rare complication which occurred in a patient with
hepatocellular carcinoma, as well as
chronic hepatitis C, after a hepatic resection. A 66-year-old man with
chronic hepatitis C and recurrent
hepatocellular carcinoma underwent a repeat hepatic resection without any
blood transfusions. In the early postoperative period, he recovered uneventfully. However, he suddenly began to suffer from a high
fever (38.4 degrees C) and severe
pancytopenia 8 days after surgery. Activated macrophages, which phagocytosed erythrocytes, were identified by a cytological study of the bone marrow. The patient was therefore treated with
methylprednisolone pulse
therapy 13 days after surgery. On the day following the initial administration of
methylprednisolone, his clinical condition drastically improved. Fortunately, with
methylprednisolone therapy, our patient recovered from acute, severe
pancytopenia. In general surgery, it is often difficult for surgeons to use
steroids due to their negative side effects. However, when symptoms such as
fever, general
fatigue and
pancytopenia are observed, even in posthepatectomy patients with
hepatocellular carcinoma and
hepatitis, a bone marrow aspiration should be performed as soon as possible, and when VAHS is suspected,
steroid pulse
therapy should be the first treatment of choice. This rare but sometimes fatal complication should thus be taken into consideration in the postoperative management of hepatectomized patients with
chronic hepatitis C.