Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
A 32-year-old male presented with a history of intermittent fever, chills, and 6-kg weight loss over six months. Upon physical examination, he had conjunctival icterus and the maximum body temperature was 40℃. Hemograms showed pancytopenia: hemoglobin, 7.9 g/dL; total leukocyte count (TLC), 1.4×109/L; absolute neutrophil count, 1.2×109/L; and platelet count, 40×109/L. Liver function test revealed: aspartate transaminase, 52 U/L; alanine transaminase, 62 U/L; alkaline phosphatase, 71 U/L; and total bilirubin, 1.3 mg/dL (conjugated bilirubin, 0.72 mg/dL). C-reactive protein concentration was 44 mg/L. Abdominal ultrasonography confirmed hepatosplenomegaly. Bone marrow examination revealed lots of histiocytes phagocytosing red blood cells, erythroblasts, and platelets along with many intrahistiocytic and extracellular