TY - JOUR T1 - Fever and pancytopenia in a patient with Crohn's disease JF - Gut JO - Gut SP - 1327 LP - 1327 DO - 10.1136/gutjnl-2012-303632 VL - 62 IS - 9 AU - Robert Weinkove AU - Michelle Dickson AU - Elena Eliadou AU - Nigel Henry Stace AU - Louise Goossens AU - Peter Ferguson Y1 - 2013/09/01 UR - http://gut.bmj.com/content/62/9/1327.abstract N2 - 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 … ER -