A previously healthy 7-month-old boy was referred for fever and abdominal distension which had started 3 days previously. At admission, the patient had a compromised clinical condition and signs of severe sepsis. His abdomen was distended, presenting marked hepatosplenomegaly. The laboratory investigation revealed anemia (Hb 7.6 g/dL), a leukocyte count of 3.86 × 109/L (77% neutrophils, 15% lymphocytes), severe thrombocytopenia (29 × 109/L), and an elevated C-reactive protein (390 mg/L). Community pneumonia was confirmed after a chest X-ray analysis.
Due to hepatosplenomegaly and cytopenias, a bone marrow sample was analyzed and the results revealed intense infiltration by gram-positive bacteria arranged in chains, free in the smear and in the cytoplasm of neutrophils and macrophages (Figure 1).11 Jha A, Adhikari RC, Sarda R. Bone marrow evaluation in patients with fever of unknown origin. J Pathol Nepal. 2012;2(3):231-240.,22 Weinzierl EP, Arber DA. The differential diagnosis and bone marrow evaluation of new-onset pancytopenia. Am J Clin Pathol. 2013;139(1):9-29. Blood and pleural effusion cultures revealed the rapid growth of Streptococcus pyogenes colonies.
References
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1Jha A, Adhikari RC, Sarda R. Bone marrow evaluation in patients with fever of unknown origin. J Pathol Nepal. 2012;2(3):231-240.
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2Weinzierl EP, Arber DA. The differential diagnosis and bone marrow evaluation of new-onset pancytopenia. Am J Clin Pathol. 2013;139(1):9-29.
Publication Dates
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Publication in this collection
24 July 2020 -
Date of issue
Apr-Jun 2020
History
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Received
12 May 2019 -
Accepted
20 May 2019 -
Published
23 July 2019
