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Blood, 15 February 2005, Vol. 105, No. 4, pp. 1648-1651.
Prepublished online as a Blood First Edition Paper on October 5, 2004; DOI 10.1182/blood-2004-08-2997.
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Submitted August 4, 2004
Accepted September 27, 2004
Macrophage activation syndrome: characteristic findings on liver biopsy illustrating the key role of activated, IFN- -producing lymphocytes and IL-6-and TNF- -producing macrophages
An D Billiau*, Tania Roskams, Rita Van Damme-Lombaerts, Patrick Matthys, and Carine Wouters
Pediatric Rheumatology, University Hospital Gasthuisberg, Leuven, Belgium; Laboratory of Experimental Transplantation, University of Leuven, Leuven, Belgium
Department of Histopathology, University Hospital Gasthuisberg, Leuven, Belgium
Pediatric Transplantation, University Hospital Gasthuisberg, Leuven, Belgium
Laboratory of Immunobiology, Rega-institute for Medical Research, University of Leuven, Leuven, Belgium
Pediatric Rheumatology, University Hospital Gasthuisberg, Leuven, Belgium
* Corresponding author; email: an.billiau{at}med.kuleuven.ac.be.
Macrophage Activation Syndrome (MAS) is a rare and potentially fatal disorder, thought to result from uncontrolled activation and proliferation of T cells and excessive activation of macrophages. The term MAS designates a clinicopathological entity that occurs in different hemophagocytic syndromes (HS). Primary hemophagocytic lymphohistiocytosis (HLH) is recognized to have an immunogenetic basis, but in the secondary HS (also referred to as secondary HLH), the cause is unknown. The pathogenesis of the accelerated disease phase typical of MAS remains incompletely understood. This report describes the immunohistochemical findings on liver tissues of five children, each of whom presented with MAS in the context of a different type of HS. The data provide direct evidence for the involvement of activated CD8+ lymphocytes through the production of IFN- , and of macrophages through hemophagocytosis and production of IL-6 and TNF- , and underscore the view that MAS in different HS share a common effector pathway.

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