我觉得这个回复很不礼貌。病人的情况并不是经过新冠感染产生HLH，而是通过辉瑞疫苗的治疗产生严重的并发症。具体是不是因为抗原的原因，看报告和文章的叙述完全不清楚。现在的问题不仅仅是“实在严重的话考虑用单抗（Emapalumab），等到自免疫反应自己慢慢消退”，而是病人已经用过Emapalumab，而此后情况又出现复发。这是非常严重的情况。

She was started on steroids (50mg prednisone / day). Her fever persisted for the next few weeks, but her lab values began to normalize the week after starting steroids. By week 8, she only had fever one day, to slightly above 38 degrees celsius and her lab values were continuing to normalize and she thought she was improving. However on Week 9, (07/19/21), temperature increased to 39 and stopped responding to NSAIDs; she continued to be febrile on an off until 7/23/21, so she returned to the previous outside hospital because her temperature reached 40.8 C and lasted at least one hour. 

你看一下VAERS上的报告关于Emapalumab的部分，病人已经用过了：

She was started on HLH directed therapy per HLH94 regimen but she was intolerant refractory to etoposide (neutropenia, persistent fevers), so she was started on treatment with emapalumab on 8/20/21, to which she responded and maintains a response (fevers resolved, counts improved, ferritin improved). She continues to follow up as an outpatient as of 9/7/21.

楼主自己说

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但是结果疗程后，数据立马开始反弹了，血红蛋白也开始下降。医生现在又提出新的假设，但感觉也不是很有把握，全套检测都重新做，包括骨髓穿刺。这一套坐下来生理心理都挺伤的。

”

如果一定要用激素，这个情况需要考虑methylprednisolone，而且是1000mg每天以上的大剂量服用。HLH复发后死亡率高达20%-88%，而且常常只有几个月。现在的情况已经非常，非常糟糕了，你再提“等到自免疫反应自己慢慢消退”又有什么意义？如果再继续不消退，怎么处理？

我不是医生，不想提出可能令人误会的建议。但看到这个实在不知道说什么好。