Haemorrhage and fever in the Munchausen syndrome.

fundus which have never been described in association with tropical eosinophilia strengthened our suspicion and we decided to start treatment with steroids and antileukaemic drugs, e.g. 6-mercaptopurine and Myleran. Enlargement of lymph nodes, sternal tenderness and leukaemic retinitis have been described in association with eosinophilic leukaemia (Norlander, 1951). Odeberg (1965) after a critical review of the literature was unable to find a single case of uncomplicated eosinophilic leukaemia and found evidence of multi-system involvement some time or other. According to him eosinophilic leukaemia and disseminated eosinophilic collagen disease (DECD) may be variants of the same condition. Pulmonary infiltration as revealed in the serial X-rays, enlargement of the lymph nodes, sternal tenderness, ocular changes and hepatosplenomegaly in our case undoubtedly point towards widespread involvement of various organs, consistent with the description of Engfeldt & Zetterstroms (1965) who considered this as a separate entity. We feel that our case satisfies the criteria of both these groups of workers and provides additional evidence that eosinophilic leukaemia and disseminated eosinophilic collagen disease are but two stages or aspects of the same disease. Acknowledgments We are extremely grateful to Professor C. V. Harrison for the microscopic study of the lymph node and his generous help in getting the child admitted in the Royal Postgraduate Medical School. We are no less grateful to Professor J. V. Dacie and Dr Scopes who very kindly sent us the case note summary covering the period of their supervision. It would have been impossible to publish this without their help and co-operation.