The patient's liver function tests showed the following results: ALT 101 U/l (6 to 53 U/l), AST 369 U/L (2 to 60 U/l), alkaline phosphatase 329 U/l (40 to 200 U/l), GGTP 1055 U/L (10 to 80 U/l), total bilirubin 39 micromol/l (0 to 17 micromol/l), and LDH 10,800 U/l (300 to 620 U/l). Her blood gases showed PO 2 76 mmHg (85 to 90 mmHg), PCO 2 31.8 mm/Hg (30 to 44 mmHg), HCO 3 17.1 mmol/l (18 to 24 mmol/l) and pH 7.34 (7.38 to 7.42). Her coagulation profile disclosed a new alteration in the INR (international normalized rate) with values of 1.57 (1 to 1.4) and hypofibrinogenemia of 90 mg% (normal values at 140 to 400 mg%). Polymerase chain reaction (PCR) tests for CMV, EBV and HSV were performed on the patient and the results were all negative. A second BM biopsy, which was performed in order to rule out malignancy (possibly indicated by spiking fever, arthralgias, sore throat, leukocytosis and maculopapular rash), revealed impressive hemophagocytosis. The serum level of beta 2 microglobilin was higher than 12,000 mg/ml (normal value <2000), serum IL-2 receptor (IL-2R) was 1000 IU/ml (normal value <500 IU/ml) and serum tumor necrosis factor (TNF) was lower than 20 pg/ml. The patient was transferred to the intensive care unit and was intubated and ventilated with high positive end expiratory pressure (PEEP) levels.