Blood Res 2014; 49(1): 6  https://doi.org/10.5045/br.2014.49.1.6
Hemophagocytosis in the pleural fluid of a patient with hemophagocytic lymphohistiocytosis
Eun-Jae Chang1, Tae-Eun Kim2, and In-sang Jeon1*

1Department of Pediatrics, Graduate School of Medicine, Gachon University, Incheon, Korea.

2Department of Pathology, Graduate School of Medicine, Gachon University, Incheon, Korea.

Correspondence to: Correspondence to In-sang Jeon, M.D., Department of Pediatrics, Gil Hospital, Gachon University, 34, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 405-835, Korea, isjeon@gilhospital.com
Published online: March 24, 2014.
© The Korean Journal of Hematology. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 

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A 1 5/12-year-old girl was admitted with persistent high fever accompanied by mild cough. Physical examination revealed moderate hepatomegaly and splenomegaly. Laboratory tests revealed bicytopenia (hemoglobin level, 10.5 g/dL; white blood cell count, 2.9×109/L; neutrophil count, 0.5×109/L; and platelet count, 14.0×109/L) and prolonged prothrombin time (16.4 sec [normal range, 9.5-13.0 sec]) and activated partial thromboplastin time (47.3 sec [normal range, 24.0-43.5 sec]) with hypofibrinogenemia (plasma fibrinogen level, 0.8 g/L). Blood chemistry results were as follows: aspartate aminotransferase, 2,347 U/L; alanine aminotransferase, 900 U/L; lactate dehydrogenase, 4,350 U/L; triglyceride, 157 mg/dL; and ferritin, >16,500 µg/L. Serology test results were negative for Epstein-Barr virus and cytomegalovirus, and results of genetic mutation associated with hemophagocytic lymphohistiocytosis (HLH) were also negative. Bone marrow findings were compatible with HLH (proliferation of histiocytes, approximately 50% showing hemophagocytosis; A). Chest imaging showed pleural effusion in both lungs. Pleurocentesis was performed before bone marrow examination, and pleural fluid cytology analysis showed evidence of lymphocytes, neutrophils, and erythrocytes being engulfed by histiocytes (B). Careful body fluid investigation is necessary to detect histiocyte-mediated hemophagocytosis when evaluating patients with suspected HLH, to confirm the diagnosis.



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