Bone marrow abnormalities in HIV infected children, report of three cases and review of the literature
A 7-year-old boy presented with pain in limbs since two years, recurrent otorrhea since one year, cough since four months, breathlessness since eight days and edema of feet since two days. He was diagnosed as having pulmonary tuberculosis (TB) two months back and was on direct observed therapy (DOTS) for same. On examination, he was malnourished and had tachycardia, tachypnea with respiratory distress and hypotension. He had severe pallor with anasarca and clubbing Grade III with generalized papular dermatitis with left ear purulent discharge and oral thrush. Systemic examination revealed cardiomegaly with gallop rhythm, hepatosplenomegaly and decreased air entry in left infrascapular region. HIV ELISA by two different kits was positive. Hemogram showed severe anemia (hemoglobin = 1.9 gm/dl) with thrombocytopenia (30,000.cumm), normal WBC count and ESR of 130 mm at end of one hour. X-ray chest showed left midzone and lower zone haziness and sputum for AFB on smear was positive. His serum biochemistry revealed hypoproteinemia, hypocalcemia, hypokalemia. Urine examination had 2+albuminuria and urine albumin/creatinine ratio was three. Ultrasound of abdomen showed hepatosplenomegaly with multiple abdominal lymph nodes. Bone marrow examination showed hypoplastic marrow with no megakaryocytes at all. There were no malignant cells. Echocardiography was normal. He was treated with IV antibiotics, antituberculous therapy, blood transfusion and dobutamine infusion; however he succumbed to his disease after seven days of admission.