The figures (or the slides themselves) do not repreduce too well in this case, but No.2 seems to present foci of ALIP. Same does Fig.8. As a matter of fact there seems to be some hypocellularity in this bone marrow.

Flow cytometry and kariotyping looking for CML (t18;22) may be of some aid.

I am worried about myelodysplasia but I agree, cannot rule out myeloproliferative disorder. All the other possibilities: infection, drug therapy, toxic exposure (lead?), should be considered. Autoimmune disorder remains a possibility, despite the negative serology.

Very difficult case, please post a follow up.

Is there a hepato/splenomegaly?

The BM has some features sugestive of a hemophagocytic syndrome (viral-related?).

Cumprimentos,

Pedro

Médula hipercelular global con presencia de los 3 sistemas. Se observan células con citoplasma abundante acidofilo ??????.

Se ha realizado biopsia de piel????

Se deben realizar marcadores para mastocitos para excluir (Mast cell disease) con toma de la médula ósea.

Saludos

Dr. Isidro Machado y Dra Concepción Ochoa Ochoa

I agree with Dan Pankowsky: it's a very difficult case.

I think about an infectious process. In some pictures (as Figura_5 and Figura_8) I see cells that might be histiocytes with dark cytoplasmic points that may be microorganisms.

Did you rule out visceral leishmaniasis?

____________

Estoy de acuerdo con Dan Pankowsky: es un caso muy difícil. Me parece que pueda tratarse de un proceso infeccioso. En algunas imágenes (como en [ Figura_5 ] y [ Figura_8 ]) se ven células que pudieran ser histiocytes con puntos citoplásmicos oscuros que me sugieren microorganismos.

¿Se descartó una leishmaniasis visceral?

Mielodisplasia.

Saludos, David

We are finishing the 2nd week after we opened the case of Dr Singh. Are there new clinical or pathological data? Perhaps new (and bigger) pictures would stimulate the discussion.

Regards,

Antonio Félix Conde

Hospital Can Misses

Ibiza

Spain