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Fever, hepatosplenomegaly and pancytopenia in a patient living in the Mediterranean region.
  1. Y. Büyükaşik,
  2. N. S. Ileri,
  3. I. C. Haznedaroğlu,
  4. H. Demiroğlu,
  5. S. Dündar
  1. Department of Adult Haematology, Hacettepe University Medical School, Ankara, Turkey.


    A 24 year old woman living in the Mediterranean region of Turkey present with a three-month history of weight loss and irregular fever that was peaking at 40 degrees C with shivering. No definite aetiology could be identified in a local hospital. A bacterial infection had been suspected, but antibiotic therapy, at first with sulbactam-ampicillin and later with azithromycin, had no influence on the fever. Physical examination revealed an emaciated patient with fever (39 degrees C), pallor, and hepatosplenomegaly (spleen 9 cm and liver 5 cm palpable below the costal margin). No peripheral lymphadenopathy was present. The laboratory examinations are summarised in the table. Notably, a prominent increase of macrophages containing intracellular micro-organisms (figures 1 and 2) was seen in the bone marrow smears. The same micro-organisms were also identified within the Kupffer cells in liver biopsy.

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