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  • Title: Hemophagocytosis and granulomas in the bone marrow of a child with Down syndrome.
    Author: Sakhalkar VS, Rao SP, Gottessman SR, Miller ST.
    Journal: J Pediatr Hematol Oncol; 2001 Dec; 23(9):623-5. PubMed ID: 11902310.
    Abstract:
    Persistent fever with pancytopenia and hepatomegaly with negative blood cultures and no obvious focus of infection in a child with Down syndrome should arouse a suspicion of leukemia. Bone marrow examination and clot biopsy from one such patient revealed hemophagocytosis and granulomas, with serologic evidence of recent Epstein-Barr virus infection. Bone marrow granulomas are not a feature of Epstein-Barr infection. Later, bone marrow culture and repeat blood culture grew Salmonella typhi. Thus, in a febrile child, when performing a bone marrow aspirate, a clot biopsy and culture for infectious etiology may be helpful, even when leukemia is strongly suspected.
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