[Reactive hemophagocytosis syndrome as a rare cause of fatal pancytopenia].
METHODS
We present the case of a feverish 36-year-old female patient with unspecific pain and weight loss. After initial diagnosis of an unclear infection with Candida esophagitis, unspecific duodenitis, proctitis and liver damage there was a further clinical deterioration during antibiotic and symptomatic therapy. A newly developed pancytopenia could be identified as caused by reactive hemophagocytosis using bone marrow analysis. The patient died despite maximal supportive and specific therapy. Cause of death was a retroperitoneal hematoma and an invasive aspergillosis, the latter not identified premortem.


CONCLUSIONS
The reactive infect-associated hemophagocytosis is a rare differential diagnosis in feverish pancytopenia. The prognosis is poor. In absence of a proven causal therapy supportive therapy and maximal diagnostics for detection of curable underlying diseases are essential. Antimycotic therapy should be considered generally.
Kulemann
J E
JE
Medizinische Klinik I, Abteilung Gastroenterologie und Infektiologie, Städtischen Kliniken Oldenburg. Jekulemann@aol.com
del Valle
F
F
Höhn
P
P
Bär
U
U
D000328:Adult; D001228:Aspergillosis / Q000150:complications / Q000473:pathology; D001853:Bone Marrow / Q000473:pathology; D002177:Candidiasis / Q000150:complications / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D005759:Gastroenteritis / Q000150:complications / Q000473:pathology; D006465:Hemoperitoneum / Q000209:etiology / Q000473:pathology; D015616:Histiocytosis, Non-Langerhans-Cell / Q000150:complications* / Q000473:pathology; D006801:Humans; D010198:Pancytopenia / Q000209:etiology* / Q000473:pathology