TY - JOUR T1 - An important complication of a child with juvenile idiopathic arthritis: macrophage activation syndrome JF - BMJ Case Reports DO - 10.1136/bcr-2013-200397 VL - 2013 SP - bcr2013200397 AU - Yuvaram N V Reddy AU - Navin Bhatia AU - Julius Xavier Scott AU - Priyathersini Nagarajan Y1 - 2013/09/11 UR - http://casereports.bmj.com/content/2013/bcr-2013-200397.abstract N2 - 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. ER -