{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T21:17:30Z","timestamp":1790371050428,"version":"4.1.0"},"reference-count":148,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,6,22]],"date-time":"2024-06-22T00:00:00Z","timestamp":1719014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Macrophage activation syndrome (MAS) is a life-threatening systemic hyperinflammatory syndrome triggered by various infections, particularly viral infections, autoimmune disorders, and malignancy. The condition is characterized by an increased production of proinflammatory cytokines resulting in a cytokine storm and has been associated with poor clinical outcomes. During the COVID-19 pandemic, patients with severe manifestations developed features similar to those of MAS, although these characteristics remained well defined within the lung. Additionally, other viral infections including EBV, the herpes family of viruses, hepatitis viruses, influenza, HIV, and hemorrhagic fevers can be complicated by MAS. The diagnosis and management of the condition remain challenging due to the lack of consensus on specific guidelines, especially among the adult population. Currently, therapeutic options primarily rely on medications that are typically used to treat primary hemophagocytic lymphohistiocytosis, such as corticosteroids and etoposide. In addition, cytokine-targeted therapies present promising treatment options. The objective of this review is to discuss the emergence of MAS in the context of viral infections including, but not limited to, its occurrence in COVID-19.<\/jats:p>","DOI":"10.3390\/v16071004","type":"journal-article","created":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T03:53:43Z","timestamp":1719201223000},"page":"1004","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Macrophage Activation Syndrome in Viral Sepsis"],"prefix":"10.3390","volume":"16","author":[{"given":"Despoina","family":"Papageorgiou","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Patras, Rio, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charalambos","family":"Gogos","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Patras, Rio, 26504 Patras, Greece"},{"name":"Metropolitan General Hospital, 15562 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4289-9494","authenticated-orcid":false,"given":"Karolina","family":"Akinosoglou","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Patras, Rio, 26504 Patras, Greece"},{"name":"Department of Internal Medicine and Infectious Diseases, University of Patras, Rio, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1093\/rheumatology\/key006","article-title":"Macrophage activation syndrome in adults: Recent advances in pathophysiology, diagnosis and treatment","volume":"58","author":"Carter","year":"2019","journal-title":"Rheumatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1146\/annurev-med-061813-012806","article-title":"Pathogenesis of macrophage activation syndrome and potential for cytokine-directed therapies","volume":"66","author":"Schulert","year":"2015","journal-title":"Annu. 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