PMC3279323_01
A) Giemsa staining of the bone marrow biopsy. Morphological signs of hemophagocytosis with numerous macrophages engulfing various cellular elements in their cytoplasm. B) Immunohistochemical analysis for CD68 in the bone marrow biopsy utilizing the PGM-1 antibody.
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Bone marrow cytology and histology revealed several histiocytes with phagocytosis of erythrocytes and platelets (Figure 1).
Changes in laboratory parameters during the clinical course of the patient. The blue arrays indicate the administration of immunoglobulins (1 g/kg) on days 4 and 5, the red arrows indicate therapy with etoposide (150 mg/m2).
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EBV copy numbers slowly decreased, and laboratory signs of HPS as severe hypofibrinogenemia and hyperferrtinemia improved (Figure 2), but pancytopenia persisted and the patient was supported with massive transfusions of blood and fresh frozen plasma, granulocyte-colony stimulating factor (G-CSF), and antibiotics.