Sepsis and Macrophage Activation Syndrome: Two Successive Complications of Staphylococcus aureus Infection

Abstract

The macrophage activation syndrome (MAS) and the sepsis are both a condition of hyperinflammation. The differential diagnosis can be difficult. The two pathologies can succeed with each other. The purpose of this literature review is to illustrate these diagnostic and therapeutic difficulties through a reported case of a macrophage activation syndrome secondary to infection (MASI). It was a 42-year-old diabetic man, hospitalized for an acute myositis due to an infection of Staphylococcus aureus. These germs caused a septic shock requiring antibiotic therapy. After an initial clinical improvement, the diagnosis of MASI post-Staphylococcus aureus was retained with a persistence of the inflammatory syndrome and appearance of fever with splenomegaly associated with hepatic cytolysis a 30% decrease in prothrombin time, a mild regenerative anemia without hemophagocytosis. An inflammatory syndrome may have several completely opposite etiologies and pathophysiology. Our case fulfilled both of the criteria of sepsis and MAS. Several signs were common for the two pathologies, but a detailed analysis of the clinical and biological elements lead to the diagnostic orientation.