CLINICAL HISTORY
A 14-year-old Caucasian male presented with a one-month history suggestive of a viral respiratory infection with fatigue, cough, and urticaria. Physical examination was remarkable for a low-grade fever and otitis. A diagnosis of a viral illness was made with a prescription of antibiotics for otitis.
His past medical history was remarkable for staphylococcal osteomyelitis of the hip at the age of two years for which he received a prolonged course of antibiotics.
His respiratory symptoms improved over the following weeks, but he remained fatigued and complained of mild joint pain. Physical examination revealed splenomegaly at 4 -5 cm below the costal margin. There were no neurological symptoms. The patient underwent a bone marrow biopsy.
LABORATORY DATA
CBC findings included a WBC count of 2500/mm3, a hemoglobin of 11.9 g/dl, and a platelet count of 93,000/mm3. Absolute neutrophil count was 1400/mm3.
ANCILLARY STUDIES
Noncontributory.
GROSS PATHOLOGY
Noncontributory.
MICROSCOPIC PATHOLOGY
Wright-Giemsa-stained BM aspirate (Figure 1) shows cells demonstrating blue cytoplasm with striated appearance. A view of his H and E-stained BM biopsy is shown (Figure 2). |
