An important complication of a child with juvenile idiopathic arthritis: macrophage activation syndrome. (11th September 2013)

• Record Type: Journal Article
• Authors: Reddy, Yuvaram N V; Bhatia, Navin; Scott, Julius Xavier; Nagarajan, Priyathersini
• Is Part Of: BMJ case reports. Volume 2013
• Publication Date: 2013-09-11
• Subjects: Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2013-200397
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : A 4-year-old girl, a known case of juvenile idiopathic arthritis for 2 years presented to us with high-grade fever and abdominal distension for 2 months. On examination, her temperature was 104°F and she was found to be pale with bilateral cervical lymphadenopathy of up to 3×3 cm in size. Her liver was enlarged with a firm consistency and a span of 12 cm. Her spleen was enlarged up to 3 cm along its long axis. The rest of her systemic examination was normal. Laboratory investigations revealed leucocytosis, anaemia and thrombocytopenia with a mildly elevated erythrocyte sedimentation rate. Serum ferritin was 16 500 ng/dL and lactate dehydrogenase was 2311 U/L. A bone marrow aspirate showed macrophages showing ingested nuclei. She was diagnosed as having macrophage activation syndrome and was initiated on intravenous methylprednisolone 300 mg daily for 3 days and was switched over to oral prednisolone 2 mg/kg/day. She is currently doing well on follow-up.