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Infection-associated MAS

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Prof Arun K Baranwal, Chandigarh    19 January 2018

  1. Macrophage activation syndrome (MAS) is a life-threatening complication of rheumatic disease, especially Infections may lead to MAS. Common causes include viruses (dengue, EBV, CMV, Herpes simplex, varicella, HIV), bacteria (Salmonella, tuberculosis), Rickettsia (Scrub typhus), parasites (Malaria, Kala-azar).
  2. It is caused by the activation and uncontrolled proliferation of T cells and macrophages.
  3. This leads to widespread hemophagocytosis and cytokine overproduction.
  4. It is difficult to recognize the switch from sepsis to MAS. Differentiating the cause (i.e., sepsis) from its consequence (i.e., MAS) is difficult. However, differentiation is essential for selecting appropriate intervention in a timely manner.
  5. High-degree of suspicion is thus required.
  6. With hyperferritinemia (>2,000), the likelihood of MAS is high. Very high ferritin (>10,000) may be a surrogate of confirmatory tests for infection-associated MAS.
  7. Early recognition and prompt treatment may be life-saving.
  8. Less immunosuppressive therapy may be enough.

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