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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
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http://dx.doi.org/10.1136/gutjnl-2012-303632

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    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 …

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