Erythrophagocytosis in Bone Marrow: A Clue to Pyrexia of Unknown Origin

Yıl 2018, , 73 - 75, 20.06.2018

Neha Garg Surabhi Raina Mrinalini Kotru Meera Sikka

https://doi.org/10.5799/jmid.434605

Öz

ABSTRACT

Bone
marrow (BM) is usually done to investigate the patients for Pyrexia of Unknown
Origin (PUO). However, only 16.5 % of cases reveal any diagnostic information.
Increasing incidence of atypical presentations are seen in typhoid. Careful
examination of BM to pick up clues for diagnosis is important We report a case
of a 15 year old female who presented with fever since associated with altered
sensorium, gum bleeding and loose stools. Hematological findings revealed
pancytopenia with macrocytic anemia with erythrophagocytosis in BM aspirates. A
diagnosis of typhoid was made with a positive typhi dot IgM. The authors
present this case to highlight the importance of simple BM findings of
erythrophagocytosis and how awareness about this feature can point towards the
right diagnosis in the midst of atypical clinical and hematological features. J Microbiol Infect Dis 2018; 8(2):73-75.

Anahtar Kelimeler

Bone marrow, typhoid fever, fever, macrophages, phagocytosis

Kaynakça

• REFERENCES 1) Gupta R, Setia N, Arora P, Singh S, Singh T. Hematological profile in pyrexia of unknown origin: role of bone marrow trephine biopsy vis-à-vis aspiration. Hematology. 2008;13(5):307-312 2) Iqbal N, Basheer A, Mookkappan S, et al. Clinicopathological Profile of Salmonella Typhi and Paratyphi Infections Presenting as Fever of Unknown Origin in a Tropical Country. Mediterr J Hematol Infect Dis. 2015; 7(1):e2015021. 3) Muniraj K, Padhi S, Phansalkar M, Sivakumar P, Varghese RG, Kanungo R. Bone Marrow Granuloma in Typhoid Fever: A Morphological Approach and Literature Review. Case Rep Infect Dis 2015; 2015:628028. 4) Dutta TK, Beeresha, Ghotekar LH. Atypical manifestations of typhoid fever. J Postgrad Med 2001; 47(4):248-51 5) Chandra H, Chandra S, Gupta V, Mahajan D. Auer Rod in a Neutrophil in a Nonmalignant Condition. Turk J Haematol 2016; 33(2):167. 6) Shin BM, Paik IK, Cho HI. Bone marrow pathology of culture proven typhoid fever. J Korean Med Sci 1994; 9(1):57-63. 7) Pilonieta MC, Moreland SM, English CN, Detweiler CS. Salmonella enterica infection stimulates macrophages to hemophagocytose. MBio 2014; 5(6):e02211-14. 8) Khalaf D, Toema B, Al-sadadi S, Al-jehani F, Sammak M. Salmonella Typhi Associated Hemophagocytic Lymphohistiocytosis in a Previously Healthy 23 Years Old Woman. Webmed Central Infect Dis 2011; 2(3):WMC001751. 9) Shah PA, Rashid A, Maqbool M, Yaseen Y, Shiekh FA. Enteric Fever Presenting as Hemophagocytic Lymphohistiocytosis (Macrophage Activation Syndrome). Webmed Central Infect Dis 2011; 2(10):WMC002331. 10) Chien YH, Lee PI, Huang LM, Lee CY, Lin DT, Lin KH. Typhoid fever presenting as infection-associated hemophagocytic syndrome: report of one case. Acta Paediatr Taiwan. 1999; 40(5):339-340. 11) Douka E, Economidou F, Nanas S. Infections Associated with the Hemophagocytic Syndrome. Hosp Chron 2012; 7(1):16–24. 12) Jin SY, Lee KW, Kim TS. A study on the typhoid granuloma in the bone marrow biopsy of patients with typhoid fever. Korean J Pathol 1986; 20(4):462-469.