Role of Bone Marrow Examination in the Evaluation of Infections: Clinico-Hematological Analysis in a Tertiary Care Centre.

OBJECTIVE: Bone marrow examination (BME) is an important modality for investigation of case of pyrexia of unknown origin (PUO). However, its yield in the diagnosis of infections has not been extensively studied and its role has not been well established. The aim of the study was to investigate the usefulness of BME and to evaluate the etiological and clinico-hematological profile in cases of bone marrow infections. MATERIAL AND METHOD: This was a retrospective study where bone marrow cases were retrieved and a review of bone marrow findings with an infectious etiology from July 2014 to June 2018 was done. Detailed history, clinical examination and hematological parameters at presentation were recorded. Clinico-hematological correlation using descriptive statistics was performed. RESULTS: The study included 55 cases, on analysis of which the maximum number of infections were those of leishmaniasis accounting for 35%, followed by HIV (29%) and tuberculosis (15%). Other etiological agents included fungal infections (histoplasmosis and aspergillosis), Enteric fever, Scrub typhus, parvovirus, falciparum malaria and filariasis. The most common clinical presentation was fever (80%) and the most common clinical finding was splenomegaly (66%). CONCLUSION: Bone marrow examination is an important diagnostic tool to delineate etiological diagnosis in infectious conditions, particularly those presenting with PUO. Moreover, it is particularly important if urgent diagnosis is required or if alternate diagnostic modalities have not revealed a reason for PUO.

Unusual presentation of disseminated histoplasmosis in an immunocompetent patient.

Disseminated histoplasmosis (DH) is a systemic granulomatous disease caused by the fungus Histoplasma capsulatum. This disease occurs mainly in immunocompromised individuals with CD 4 counts less than 200 cell/µL and is rarely noted in immunocompetent person. In India, this disease has been reported from several parts of the country of which most cases are from eastern India which is considered to be endemic for this disease. Inhalation of the spores can lead to a self-limiting flulike illness in immunocompetent hosts. The most common organs involved are liver, spleen, bone marrow, lymphoreticular system, and gastrointestinal tract. Cutaneous manifestations of histoplasmosis are rare and are seen predominantly in persons with advanced human immunodeficiency virus (HIV) infections. We present a case of DH with generalized cutaneous lesions in a non-HIV infected adult which posed a diagnostic challenge to our clinical colleagues.

Primary Endometrial Squamous Cell Carcinoma In Situ: Report of a rare disease.

Squamous cell carcinoma (SCC) of the endometrium, whether primary or secondary to cervical cancer, is a rare entity. Primary endometrial squamous cell carcinoma in situ is even more uncommon; it usually occurs in postmenopausal women and has a strong association with pyometra. We report a 60-year-old multiparous postmenopausal woman who presented to the Hakeem Abdul Hameed Centenary Hospital, New Delhi, India, in May 2014 with a lower abdominal swelling corresponding in size to a pregnancy of 26 gestational weeks and vaginal discharge of one year's duration. A total abdominal hysterectomy with a bilateral salpingooophorectomy was performed, which revealed an enlarged uterus with pyometra. Histopathology showed that the entire endometrial lining had been replaced with malignant squamous cells without invasion of the myometrium. Immunohistochemistry revealed that the tumour cells were positive for p63 with a high Ki-67 labelling index. No adjuvant therapy was required and the patient was disease-free at a seven-month follow-up.

Postoperative thrombocytosis: An unusual case report.

Thrombocytosis is often an incidental finding seen in 35-50% of cases and the cause determination creates a diagnostic challenge. Extreme thrombocytosis is rare and seen in 2-5.8% patients only. Among the various causes of increased platelet count, surgical procedures have attracted much attention in both experimental and clinical domain. The appearance of thrombocytosis after surgery needs to be diagnosed to establish the type of thrombocytosis (clonal or reactive), as treatment and prognosis are quite different between them. This case report is vital because of two reasons: First, the increase in platelet count is difficult to rationalize than many of the other thrombocytoses, such as those related to primary augmentation of the function of the bone marrow; second, the association of platelets with the clotting process has led to the belief that their increase after a surgical procedure is connected with the occurrence of postoperative thrombosis. This case presents an interesting finding from a patient who has undergone major abdominal surgery and has shown an unexpected perpetual increase in platelet count.