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Vol. 42. Issue 2.
Pages 188-189 (April - June 2020)
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Vol. 42. Issue 2.
Pages 188-189 (April - June 2020)
Images in Clinical Hematology
DOI: 10.1016/j.htct.2019.05.001
Open Access
Massive bone marrow infiltration by Streptococcus pyogenes during severe community pneumonia
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Tayrine Fernanda Micheli de Oliveira, Pollyana Cristina Bernardes Valize, Leonardo Rodrigues de Oliveira
Corresponding author
leonardorodoli@hotmail.com

Corresponding author at: Rua Getúlio Guaritá, 130, 38025-440 Uberaba, MG, Brazil.
Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
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A previously healthy 7-month-old boy was referred for fever and abdominal distension which had started 3 days previously. At admission, the patient had a compromised clinical condition and signs of severe sepsis. His abdomen was distended, presenting marked hepatosplenomegaly. The laboratory investigation revealed anemia (Hb 7.6g/dL), a leukocyte count of 3.86×109/L (77% neutrophils, 15% lymphocytes), severe thrombocytopenia (29×109/L), and an elevated C-reactive protein (390mg/L). Community pneumonia was confirmed after a chest X-ray analysis.

Due to hepatosplenomegaly and cytopenias, a bone marrow sample was analyzed and the results revealed intense infiltration by gram-positive bacteria arranged in chains, free in the smear and in the cytoplasm of neutrophils and macrophages (Figure 1).1,2 Blood and pleural effusion cultures revealed the rapid growth of Streptococcus pyogenes colonies.

Figure 1.

Bacteria free in the bone marrow smear (arrowhead) and in the cytoplasm of macrophages (arrow). Leishman stain. Magnification 1000×.

(0.17MB).
Conflicts of interest

The authors declare no conflicts of interest.

References
[1]
A. Jha, R.C. Adhikari, R. Sarda.
Bone marrow evaluation in patients with fever of unknown origin.
J Pathol Nepal, 2 (2012), pp. 231-240
[2]
E.P. Weinzierl, D.A. Arber.
The differential diagnosis and bone marrow evaluation of new-onset pancytopenia.
Am J Clin Pathol, 139 (2013), pp. 9-29
Copyright © 2019. Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular
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Hematology, Transfusion and Cell Therapy

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