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A 3-month-old infant with fever and abnormal findings in peripheral blood smear and bone radiography
, dr.elhamzarei@gmail.com
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A 3-month-old boy with fever and cough presented to the emergency department of the children's hospital four days ago. In the physical examination, the patient was febrile (temperature 38.1 ˚c), had no respiratory distress, and wheezing was heard in both lungs.
In the physical examination, firmness was palpable in the middle part of the clavicle on both sides, and the edge of the spleen was palpable below the rib cage.
In the medical history, the infant was born at normal term with normal development and had a history of inguinal hernia surgery on both sides at one month.
The laboratory findings are shown in the table below:
| Results | Parameter |
| 26.5 | WBC ) x 109/L ) |
| 28 | Segment ( % ) |
| 55 | Lymphocyte ( % ) |
| 5 | Monocyte ( % ) |
| 3 | Band ( % ) |
| 3 | Eosinophil ( % ) |
| 2 | Myelocyte ( % ) |
| 4 | NRBC ( % ) |
| 3.8 | RBC ( x1012 /L ) |
| 9.7 | Hb ( g/ L) |
| 29.4 | Hct ( % ) |
| 78 | MCV ( fl ) |
| 26 | MCH ( Pg ) |
| 33 | MCHC (g/dl) |
| 135 | Plt (x 109/L ) |
| Retic Count ( % ) | |
| 7 | ESR ( mm/hr) |
| 2 | CRP (mg/dl) |
| 4 | BUN (mg/dl) |
| 0/4 | Cr (mg/dl) |
The findings of peripheral blood smear are shown in figure 1.
Due to the COVID-19 pandemic, the patient was tested for COVID-19 PCR, which was positive.
Abdominal ultrasound revealed splenomegaly with a craniocaudal spleen diameter of 90 mm, and no pathological findings were seen in other organs.
According to the existence of anemia and thrombocytopenia as well as peripheral blood smear findings, radiographic examination of the bones was performed (figure 2)
According to the above findings, what is your diagnosis?
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