Hematology Case 54

Presented By Dr Mohammad Moharram - Dr Shehab S. Alhammadi

Released on 30-04-2021

Patient Data

27 year old male

Clinical Data

  • History:

History of fever and chills 4 months ago.

Patient visited many health care facilities during the last 3 month & received medications but without significant improvements.

Fatigue and Weight loss (10 Kg in the last 2 months).

  • On examination:

Patient looks ill and pale

No cyanosis or jaundice.

Hepatomegaly and splenomegaly without pain or tenderness.

No L.N. enlargement.

Related Laboratory Results

  • CBC:

- WBC: 1.19x103 /uL (Neutrophils: 0.33x103 /uL - Lymphocytes: 0.77x103 /uL - Monocytes: 0.09x103 /uL).

- HGB: 6.5g/dL - MCV: 73.2fL -MCH: 22pG - MCHC:30.1%

- Platelet: 201x103 /uL

  • Malaria test (Thin , Thick Slides and strips): Negative for 4 times. (3 of them at peak of fever)

  • Total bilirubin : 16 umol/L (R.R.: 5.1-20.5) - Direct bilirubin: 2.4 umol/L (R.R.: 1.7-8.6)

  • AST: 49 u/L (R.R.: 15-41) - ALT: 68 u/L (R.R.: 17-63) - ALP: 90 u/L (R.R.:30-91) - GGT: 40 u/L (7-50) - ALB: 20 g/L (R.R.: 35-50).

  • BUN: 3.9 mmol/L (R.R.: 2.5-6.4) - Creatinine: 52 umol/L (R.R.: 55-113).

  • Na: 134 mmol/L (R.R.: 135-144) - K: 4.5 mmol/L (R.R.: 3.5-5.1) - Ca: 2.01 mmol/L (R.R.: 2.2-2.5).

  • LDH: 192 u/L (R.R.: 98-192)

  • Serum Iron: 2 umol/L (5-30.5) - Serum Ferritin: 1990 ng/mL (R.R.: 13-150)

  • Vitamin B12: 506 pg/mL (R.R.: 180-914) - Serum folate: 24.6 nmol/L (R.R.: 7-30).

Provisional Diagnosis

?? Chronic Malaria

Case Picture(s) / Photo(s)

Bone Marrow Aspirate Slides

Bone Marrow Trephine biopsy Slides

Comment / Findings

  • Bone Marrow Aspirate:

Leishman Donovan Bodies are seen both intracellular and extracellular. Increased Macrophages and histiocytes, few of them contain intracellular L.D. bodies. Relatively increased plasma cells, some of them show dysplastic features.

  • Bone Marrow Trephine biopsy:

There is increased histiocytes highlighted by CD68. Foci of intracellular microorganisms consistent with leishmania promastigotes are seen.

Final Diagnosis

Bone marrow infiltration by Leishmaniasis.

Additional Note

Patient received anti-Leishmania treatment and discharged medically free after 10 days for follow up in outpatient clinic.