Liver Biopsy - Pediatric Oncall

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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	Specialist Answers
Question
Regarding the previous case I asked for, we did liver biopsy in her previous admission which was normal and we also repeated bone marrow biopsy that showed erythroid hyperplasia. Also smear for LD bodies were negative. Brucella work up was negative. Her sarcoidosis work up was also normal. Her complement levels are normal. We are waiting for c-anca and p-anca reports. And once at the age of 9 yrs she was treated as JRA due to knee joint swelling. 1 episode of GTCS+ at age of 9 yrs. I had enquired about macrophage activation syndrome also in view of this case. Thanks for ur reply. Now her urine protein also is elevated. So can we put her as JRA in the past now complicated with MAS ? Hope it'l present with repeated infections. Now she is on oral steroids after iv methyl prednisolone and she is responding well we hope. KINDLY tell how else to confirm. Our bone marrow shows only erythroid hyperplasia...no evidence of hemophagocytosis.
Answer
Check her serum ferritin levels to confirm MAS. However since she is already on methypred the levels may not be raised. However with hepatosplenomegaly, anemia, arthritis, CNS involvement and renal involvement, autoimmune disease along with MAS is likely. Hemophagocytosis may not be always picked up on MAS if done early in the disease or the child is already on treatment. Back to All Questions

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