title: Hemophagocytosis and granulomas in the bone marrow of a child with Down syndrome.
abstract: Persistent fever with pancytopenia and hepatomegaly with negative blood cultures and no obvious focus of infection in a child with Down syndrome should arouse a suspicion of leukemia. Bone marrow examination and clot biopsy from one such patient revealed hemophagocytosis and granulomas, with serologic evidence of recent Epstein-Barr virus infection. Bone marrow granulomas are not a feature of Epstein-Barr infection. Later, bone marrow culture and repeat blood culture grew Salmonella typhi. Thus, in a febrile child, when performing a bone marrow aspirate, a clot biopsy and culture for infectious etiology may be helpful, even when leukemia is strongly suspected.
authors.affiliation: Division of Hematology/Oncology, Children's Medical Center at Brooklyn, New York 11203, USA.
authors.forename: V S
authors.initials: VS
authors.lastname: Sakhalkar
authors.forename: S P
authors.initials: SP
authors.lastname: Rao
authors.forename: S R
authors.initials: SR
authors.lastname: Gottessman
authors.forename: S T
authors.initials: ST
authors.lastname: Miller
mesh_terms: D016470:Bacteremia / Q000150:complications / Q000382:microbiology; D001853:Bone Marrow / Q000382:microbiology / Q000473:pathology*; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004314:Down Syndrome / Q000150:complications* / Q000473:pathology; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D006099:Granuloma / Q000209:etiology / Q000473:pathology*; D006529:Hepatomegaly / Q000209:etiology / Q000473:pathology; D015616:Histiocytosis, Non-Langerhans-Cell / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D007938:Leukemia / Q000175:diagnosis; D008297:Male; D010198:Pancytopenia / Q000209:etiology*; D012485:Salmonella typhi / Q000302:isolation & purification*; D013163:Splenomegaly / Q000209:etiology / Q000473:pathology; D013203:Staphylococcal Infections / Q000150:complications / Q000382:microbiology; D014435:Typhoid Fever / Q000150:complications / Q000382:microbiology / Q000473:pathology*; D014552:Urinary Tract Infections / Q000150:complications / Q000382:microbiology