Question: A 53-year-old woman consulted for a fever of 15 days of evolution, without symptoms of infectious focality. On examination, a painful hepatomegaly was detected 5 cm from the costal margin and the spleen was palpated 14 cm from the left costal margin. The hemogram shows Hb 8.5 g / dL, Leucocytes 630 / mL (lymphocytes 63%, monocytes 20%, neutrophils 17%) and platelets 35,000 / mL. The biochemistry shows a moderate elevation of the liver biochemistry, LDH is normal and a polyclonal hypergammaglobulinemia (3.5 g / dL) is observed in the proteinogram. She has a history of HIV infection known for 10 years and irregular adherence to antiretroviral treatment, with recent determinations of CD4 lymphocytes 350 cells / mL and viral load of HIV 154 copies / mL. During the last 3 months she has been treated for seronegative symmetric polyarthritis with 10-20 mg / day of prednisone. Which of the following statements is correct? 
 Options:  <1> Perform a bone marrow biopsy, since the most likely diagnosis is visceral leishmaniasis. <2> Pancytopenia is justified by cirrhosis associated with virus C and would not perform further tests. <3> Probably it is a medullary toxicity by prednisone that would treat with withdrawal of the drug and filgastrim. <4> I would request a determination of ANAs to rule out disseminated systemic lupus. <5> It would intensify the antiretroviral treatment, since it is probable that all the manifestations that it presents are due to HIV.
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