Article Text

Download PDFPDF
Lung involvement in macrophage activation syndrome and severe COVID-19: results from a cross-sectional study to assess clinical, laboratory and artificial intelligence–radiological differences
  1. Piero Ruscitti1,
  2. Federico Bruno1,
  3. Onorina Berardicurti1,
  4. Chiara Acanfora1,
  5. Viktoriya Pavlych1,
  6. Pierpaolo Palumbo1,
  7. Alessandro Conforti1,
  8. Francesco Carubbi2,
  9. Ilenia Di Cola1,
  10. Paola Di Benedetto1,
  11. Paola Cipriani1,
  12. Davide Grassi3,
  13. Carlo Masciocchi1,
  14. Annamaria Iagnocco4,
  15. Antonio Barile1,
  16. Roberto Giacomelli1
  1. 1 Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Abruzzo, Italy
  2. 2 Department of Medicine, ASL 1 Avezzano Sulmona L'Aquila, L'Aquila, Abruzzo, Italy
  3. 3 Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Abruzzo, Italy
  4. 4 Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Piemonte, Italy
  1. Correspondence to Professor Annamaria Iagnocco, Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy; annamaria.iagnocco1{at}


Objectives To evaluate the clinical pictures, laboratory tests and imaging of patients with lung involvement, either from severe COVID-19 or macrophage activation syndrome (MAS), in order to assess how similar these two diseases are.

Methods The present work has been designed as a cross-sectional single-centre study to compare characteristics of patients with lung involvement either from MAS or severe COVID-19. Chest CT scans were assessed by using an artificial intelligence (AI)-based software.

Results Ten patients with MAS and 47 patients with severe COVID-19 with lung involvement were assessed. Although all patients showed fever and dyspnoea, patients with MAS were characterised by thrombocytopaenia, whereas patients with severe COVID-19 were characterised by lymphopaenia and neutrophilia. Higher values of H-score characterised patients with MAS when compared with severe COVID-19. AI-reconstructed images of chest CT scan showed that apical, basal, peripheral and bilateral distributions of ground-glass opacities (GGOs), as well as apical consolidations, were more represented in severe COVID-19 than in MAS. C reactive protein directly correlated with GGOs extension in both diseases. Furthermore, lymphopaenia inversely correlated with GGOs extension in severe COVID-19.

Conclusions Our data could suggest laboratory and radiological differences between MAS and severe COVID-19, paving the way for further hypotheses to be investigated in future confirmatory studies.

  • inflammation
  • still's disease, adult-onset
  • arthritis, juvenile

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Handling editor Josef S Smolen

  • PR and FB contributed equally.

  • AB and RG contributed equally.

  • Contributors All the authors met all criteria for authorship in the ICMJE Recommendations, since all authors made substantial contributions to the conception or design of the work, and the acquisition and interpretation of data. All authors contributed to the critical review and revision of the manuscript and approved the final version. All the authors agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The local ethics committee (Comitato Etico Azienda Sanitaria Locale 1 Avezzano/Sulmona/L’Aquila, L’Aquila, Italy; protocol number 0095184/20) approved the study, which was performed according to good clinical practice guidelines and the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.