Cytokine Storm Syndrome Associated with Hemorrhagic Fever and Other Viruses

  • Ethan S. Sen
  • A. V. Ramanan


A wide variety of infections can trigger cytokine storm syndromes including those caused by bacteria, viruses, fungi and parasites. The most frequent viral trigger is Epstein-Barr virus which is covered in Chapter “Cytokine Storm Syndromes Associated with Epstein Barr Virus”. This chapter focuses on other viruses including the hemorrhagic fever viruses, influenza, parainfluenza, adenovirus, parvovirus, hepatitis viruses, measles, mumps, rubella, enterovirus, parechovirus, rotavirus, and human T-lymphotropic virus. The published literature consists of many single case reports and moderate-sized case series reporting CSS, in most circumstances meeting the 2004 diagnostic criteria for HLH. There is no published clinical trial evidence specifically for management of HLH associated with these viruses. In some situations, patients received supportive therapy and blood product transfusions only but in most cases, they were treated with one or more of intravenous corticosteroids, intravenous immunoglobulin, and/or etoposide. These were successful in many patients, although in significant numbers progression of infection to CSS was associated with mortality.


Viral hemorrhagic fever Dengue fever Crimean-Congo hemorrhagic fever Influenza Parainfluenza Adenovirus Parvovirus Hepatitis viruses Measles Mumps Rubella Enterovirus Parechovirus Rotavirus Human T-lymphotropic virus 


Author Contributions

E. S. Sen performed a literature review and wrote the chapter. A. V. Ramanan made contributions to reviewing and editing of the manuscript before submission.

Competing Interests Statement

E. S. Sen declares no competing interests.

A. V. Ramanan has received speaker fees from SOBI.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ethan S. Sen
    • 1
  • A. V. Ramanan
    • 1
  1. 1.Pediatric RheumatologyBristol Royal Hospital for ChildrenBristolUK

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