Fever, hepatosplenomegaly and pancytopenia in a patient living in the Mediterranean region.
A 24 year old woman living in the Mediterranean region of Turkey present with a three-month history of weight loss and irregular fever that was peaking at 40 degrees C with shivering. No definite aetiology could be identified in a local hospital. A bacterial infection had been suspected, but antibiotic therapy, at first with sulbactam-ampicillin and later with azithromycin, had no influence on the fever. Physical examination revealed an emaciated patient with fever (39 degrees C), pallor, and hepatosplenomegaly (spleen 9 cm and liver 5 cm palpable below the costal margin). No peripheral lymphadenopathy was present. The laboratory examinations are summarised in the table. Notably, a prominent increase of macrophages containing intracellular micro-organisms (figures 1 and 2) was seen in the bone marrow smears. The same micro-organisms were also identified within the Kupffer cells in liver biopsy.
Büyükaşik
Y
Y
Department of Adult Haematology, Hacettepe University Medical School, Ankara, Turkey.
Ileri
N S
NS
Haznedaroğlu
I C
IC
Demiroğlu
H
H
Dündar
S
S
D000328:Adult; D005260:Female; D005334:Fever / Q000469:parasitology*; D006529:Hepatomegaly / Q000469:parasitology; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000150:complications* / Q000175:diagnosis; D010198:Pancytopenia / Q000469:parasitology*; D013163:Splenomegaly / Q000469:parasitology