Bone marrow abnormalities in HIV infected children, report of three cases and review of the literature
A 7-year-old boy presented with injury to right elbow 25 days back while playing following which after 10 days, he developed pain in the right elbow with swelling and went to a doctor who diagnosed it to be a fracture and a plaster was applied. After two days, he had fever which subsided with Sulfamethoxazole/Pyrimethamine. At that time, his peripheral smear showed trophozoites and ring forms of plasmodium vivax. Subsequently increasing pallor was noticed was the past eight days. On examination, he was pale, had tachycardia with bilateral basal crepitations, cardiomegaly and hepatosplenomegaly with healed herpetic lesion over right groin. HIV ELISA positive and confirmed by western blot test. The child was treated with diuretics and blood transfusion. He developed severe abdominal tenderness with fever after two days. Ultrasound abdomen showed hepatosplenomegaly with splenic abscesses. CT abdomen also confirmed the same. He was treated with IV antibiotics but there was no improvement. He continued to have fever, abdominal pain and pancytopenia. His serial hemograms are depicted in . A bone marrow aspiration showed erythroid hyperplasia with increased plasma cells and biopsy showed myelofibrosis. No organisms were grown on bone marrow culture and it was negative for TEL/AMLI or MLL translocations or Monosomy 7. Hepatitis C and hepatitis B surface Antigen by ELISA were negative. He succumbed to a fatal pulmonary bleed and hematemesis.