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CASE REPORT
An important complication of a child with juvenile idiopathic arthritis: macrophage activation syndrome
  1. Yuvaram N V Reddy1,
  2. Navin Bhatia2,
  3. Julius Xavier Scott2,
  4. Priyathersini Nagarajan3
  1. 1Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
  2. 2Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
  3. 3Department of Pathology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
  1. Correspondence to Dr Julius Xavier Scott, jxscott{at}hotmail.com

Summary

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.

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