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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.
Bone marrow aspirate showing a macrophage.
The patient developed rectal bleeding, refractory to blood product support and …
Footnotes
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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.
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Competing interests None.
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Patient consent Obtained.
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Ethical approval This report was produced in accordance with guidelines of National Ethics Advisory Committee of New Zealand.
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Provenance and peer review Not commissioned; externally peer reviewed.
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