Diagnostic value of bone marrow cell morphology in visceral leishmaniasis-associated hemophagocytic syndrome: Two case reports

Table 1 Pathogen detection in two patients with visceral leishmaniasis

Etiological examination	Case 1	Case 2
Epstein-Barr virus	2.82 x 103	Negative
K39 tests	Positive	Positive
Cytomegalovirus	Negative	Negative
Rubella virus	Negative	Negative
Influenza virus	Negative	Negative
Respiratory syncytial virus	Negative	Negative
Adenovirus	Negative	Negative
Antihemolytic streptococcus O	Normal	Normal
Rheumatoid factor	Normal	Normal
Anti-cyclic citrullinated peptide antibody	Negative	Negative
Anti-nuclear antibody	Negative	Negative
Legionella pneumophila	Negative	Negative
Mycoplasma pneumoniae, Chlamydia	Negative	Negative
Q fever, rickettsia	Negative	Negative
Blood culture	Negative	Negative
Bone marrow cytology
Leishmania amastigotes	Positive	Positive
Hemophagocytic cells	Easily seen	Easily seen
Hemophagocytic-related genes	Negative	Negative
Acute and chronic leukemia immunophenotyping	Negative	Negative

Table 2 Routine blood indices, infection indices, and biochemical results for both patients on admission and after hemophagocytic lymphohistiocytosis-2004 chemotherapy regimen treatment for 14 d and SSG treatment for 21 d

Detection index	Normal range	On admission		After HLH-2004 chemotherapy regimen treatment for 14 d		After SSG treatment for 21 d
Characteristic		Case 1	Case 2	Case 1	Case 2	Case 1	Case 2
White blood cell count (× 109/L)	4.0–10.0	2	4.5	3.4	3.9	4.6	5.8
Red blood cell count (× 1012/L)	4.0–5.5	2	3.8	3.3	3.3	3.83	4.08
Hemoglobin (g/L)	97-141	69	94	91	97	112	119
Platelet count (× 109/L)	100–300	35	44	66	28	118	110
High-sensitivity C-reactive protein (mg/L)	0.5-10.0	151.8	198.3	85.3	16.3	5.9	2.3
Procalcitonin (ng/mL)	0-0.25	5.4	2.3	3.5	1.8	0.25	0.25
Ferritin (μg/L)	7.0-142.0	40000	69445	1886	2000	128	116
Fibrinogen (g/L)	2.0-4.0	1.2	0.9	1.1	1.4	2.6	3.3
Alanine aminotransferase (U/L)	0-40.0	75	178	41	149	39	28
Total protein (g/L)	55.0-76.0	62.2	55.7	62.2	65.1	64.2	66.1
Albumin (g/L)	39.0-54.0	24.7	29.2	24.7	30.9	40.5	42.7
Globulin (g/L)	12.0-34.0	37.5	36.5	37.5	34.2	23.7	23.4
Lactate dehydrogenase (U/L)	109.0-245.0	2700	2648	256	1803.8	238	226
Triglycerides (mmol/L)	1.70-2.30	4.2	4.5	2	2.5	2.1	1.9

HLH: Hemophagocytic lymphohistiocytosis; SSG: Sodium stibogluconate.