You are here

Article Text

Article menu
Download PDFPDF
Editor's quiz: GI snapshot
Fever and pancytopenia in a patient with Crohn's disease
  1. Robert Weinkove1,2,
  2. Michelle Dickson1,
  3. Elena Eliadou3,
  4. Nigel Henry Stace3,
  5. Louise Goossens4,
  6. Peter Ferguson2,5
  1. 1Wellington Blood & Cancer Centre, Wellington Hospital, Capital & Coast District Health Board, Wellington, New Zealand
  2. 2Vaccine Research Group, Malaghan Institute of Medical Research, Wellington, New Zealand
  3. 3Department of Gastroenterology, Wellington Hospital, Capital & Coast District Health Board, Wellington, New Zealand
  4. 4Photography Unit, Capital & Coast District Health Board, Wellington, New Zealand
  5. 5Department of Anatomical Pathology, Capital & Coast District Health Board, Wellington, New Zealand
  1. Correspondence to Dr Robert Weinkove, Wellington Blood & Cancer Centre, Wellington Hospital, Private Bag 7902, Wellington 6242, New Zealand; robert.weinkove{at}ccdhb.org.nz

https://doi.org/10.1136/gutjnl-2012-303632

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    A 21-year-old male with ileal Crohn's disease on maintenance with azathioprine presented with fevers and pancytopenia. Erythrocyte 6-thioguanine nucleotide level was therapeutic. CT excluded an abscess and showed thickening of the rectum, sigmoid and terminal ileum. His condition failed to respond to azathioprine withdrawal, intravenous piperacillin/tazobactam and granulocyte colony-stimulating factor. Blood tests showed hyperbilirubinemia, transaminitis, marked hyperferritinemia (>7000 μg/l), hypofibrinogenemia and hypertriglyceridaemia. Bone marrow aspirate microscopy is shown in figure 1.

    Figure 1

    Bone marrow aspirate showing a macrophage.

    The patient developed rectal bleeding, refractory to blood product support and …

    View Full Text

    Footnotes

    • Contributors RW: conception and design, acquisition of data and drafting the manuscript; MD, EE, PF and LG: acquisition of data and drafting the manuscript; NS: conception and critical revision of manuscript. All authors reviewed the final manuscript.

    • Competing interests None.

    • Patient consent Obtained.

    • Ethical approval This report was produced in accordance with guidelines of National Ethics Advisory Committee of New Zealand.

    • Provenance and peer review Not commissioned; externally peer reviewed.