AgNOR counts and determination of malignancy

A 22 year old patient with severe aplastic anaemia responded to antilymphocytic globulin but developed recurrent fever despite treatment with steroids and then antibacterial, antifungal, and antituberculous drugs. There was progression, with severe joint pains and immobility associated with radiological evidence of a symmetrical destructive process. A bone marrow specimen showed no evidence of malignancy, and cultures of blood, urine, and stool were negative but enriched broth cultures of an open biopsy specimen of the humeral head grew Salmonella enteriditis phage type 4. Treatment with ciprofloxacin resulted in considerable symptomatic improvement: a total of 12 months of treatment is planned. Salmonella osteomyelitis, particularly with this unusual pattern of disease, has not previously been described in aplastic anaemia. Case report Bone and joint infections due to Salmonella are uncommon, although various predisposing conditions are recognised, particularly sickle cell anaemia.1-3 We describe a patient with aplastic anaemia who responded well to treatment with antilymphocytic globulin (ALG) but who developed severe Salmonella enteriditis (type 4) osteomyelitis. A 22 year old Greek woman presented with anaemia and thrombocytopenia (haemoglobin 5 g/dl; platelets 42 x 10/l; white cell count 3.3 x 109/1, with 46% neutrophils, 48% lymphocytes, and 6% monocytes), and investigations confirmed idiopathic aplastic anaemia. She received 15 mg/kg equine ALG (Merrieux) daily for five days infused into the subclavian vein via a line inserted into the antecubital fossa. Five days later a typical syndrome of serum sickness developed with fever, rash, and arthralgia and this responded promptly to hydrocortisone. High fever with negative blood cultures Department of Haematology, St George's Hospital, Blackshaw Road, London SW17 OQT S Allard A Laurie Department of Mlicrobiology J O'Driscoll Correspondence to: Dr S Allard Accepted for publication 4 July 1991 174 group.bmj.com on June 19, 2017 Published by http://jcp.bmj.com/ Downloaded from