PMC8767649_01
Patient's chest radiograph demonstrating bilateral diffuse infiltrates consistent with acute respiratory distress syndrome.
10.1177_23247096211052180-fig1.jpg
PMC8767649_01_10.1177_23247096211052180-fig1.jpg
fig1-23247096211052180
She became progressively hypoxemic with serial chest X-rays (Figure 1) showing bilateral interstitial infiltrates consistent with ARDS and ultimately required intubation.
Wright stain aspirate smear of bone marrow. Histiocytes are noted to be increased (black arrows) demonstrating evidence of hemophagocytosis, with one histiocyte showing ingestion of an immature granulocyte (red arrow).
10.1177_23247096211052180-fig2.jpg
PMC8767649_01_10.1177_23247096211052180-fig2.jpg
fig2-23247096211052180
Due to suspicion of HLH, a bone marrow biopsy was performed, which showed normocellular marrow with myeloid predominance, mild granulocyte atypia, and increased histiocytes (Figure 2).
H&E and CD163 immunohistochemical stain of core bone marrow biopsy.. H&E stain showing normocellular marrow for age (approximately 30-35% cellularity). CD163 stain highlighting numerous histiocytes throughout the marrow space.
10.1177_23247096211052180-fig3.jpg
PMC8767649_01_10.1177_23247096211052180-fig3.jpg
fig3-23247096211052180
CD163 immunostaining of the core biopsy revealed markedly increased histiocytes with some cells showing ingested cellular material, which is consistent with HLH (Figure 3).