He had hepatomegaly and marked splenomegaly, but the rest of the examination was within normal limits. Culture of the blood, bone marrow, and urine did not reveal any pathogens. Bone marrow aspirate was performed and the smear is shown in the above picture. The smear shows a normocellular bone marrow with hemophagocytosis, where the scattered histiocytes engulf erythrocytes, platelets and leukocytes. Hematopoietic malig-nancies, especially leukemia and lymphoma, are major considerations as well.
Hemophagocytic syndrome is an important differential in a child with such a clinical presentation.
The condition may occur in association with underlying hematopoeitic malignancies, and congenital or acquired immunodeficiency. It is an important differential diagnosis in infants presenting with fever and hepatosplenomegaly. The clinical presentation may mimic infectious mononucleosis, septicemia, malignancy, encephalitis and autoimmune disorders. Splenic puncture from a patient with hemophagocytic syndrome showing increased histiocytes and hemophagocytosis. years of age. The criteria for diagnosis of HLH are listed in Table 1.