PMC5779429_01
Timeline of events surrounding the illness of a woman with fatal dengue-associated hemophagocytic lymphohistiocytosis : New Mexico and Texas, 2012. Abbreviations: PCP = primary care physician; WNV = West Nile virus; HLH = hemophagocytic lymphohistiocytosis; DENV-3 = dengue virus-type 3.
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September 2, 2012, a woman aged 63 years went to an outpatient clinic in central Texas with a 7-day history of fatigue, anorexia, headache, hematuria, and leg pain (Figure 1). She had a history of Crohn's disease treated with mercaptopurine and mesalamine, hysterectomy because of uterine cancer, thyroidectomy, hypertension treated with lisinopril, coronary artery disease, hyperlipidemia, chronic renal disease with microhematuria, obesity, and depression treated with fluoxetine.
Key laboratory values from hematology and liver chemistry panels for a woman with fatal dengue-associated hemophagocytic lymphohistiocytosis : New Mexico and Texas, 2012. * Laboratory values collected during routine physical examination, before illness onset.
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Laboratory values revealed leukopenia (white blood cell count = 3,600/mm3 [normal = 3,800-10,600/mm3]) (Figure 2, top panel). Laboratory results revealed thrombocytopenia (platelet count = 94,000/mm3 [normal = 140,000-400,000/mm3]) and anemia (hemoglobin = 11.3 g/dL [normal = 12.0-16.0 g/dL]) (Figure 2, top panel). Results also revealed acute liver injury (aspartate aminotransferase = 662 IU/L [normal = 10-42 IU/L]); total bilirubin = 6.5 mg/dL [normal 0.2-1.2 mg/dL]) (Figure 2, bottom panel).
Stars indicate erythrocytes phagocytized by a macrophage in a hematoxylin and eosin-stained section of bone marrow biopsy from a patient with fatal dengue-associated hemophagocytic lymphohistiocytosis : New Mexico and Texas, 2012. * Scale bar represents 10 micrometers.
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Macrophages with intracellular erythrocytes were noted in the bone marrow biopsy (Figure 3).