Pancytopenia and Acute Febrile Illness in a Female

Abstract

Patient: 52-year-old female. Chief Complaint: Fever with chills and rigor for 1 week. History of Present Illness: She was started on antimalarial treatment. She responded well and was afebrile 48 hours after initiation of therapy. She was also on regular medication for diabetes mellitus and hypothyroidism for the past 10 years. Past Medical History: Patient was admitted to the hospital with Falciparum malaria 1 month earlier and was treated for the same. She was afebrile for 3 weeks following discharge. Family History: Unremarkable. Medications: Unremarkable. Physical Examination: Mild pallor; temperature, 103°F; pulse, 100; blood pressure, 130/90; mild hepatosplenomegaly. Principal Laboratory Findings: Table 1 and Image 1 . 1. What are the most striking clinical and laboratory findings in this patient? 2. How do you explain these findings? 3. What is/are the causative agent(s) creating this patient’s condition? 4. What is the geographical distribution of the organism causing this illness? 5. What are the modalities used to diagnose this condition? 6. What is the explanation for the low peripheral yield of the organism causing this condition? 7. Which organisms, other than the 1 causing fever in this patient, can be seen in the blood/bone marrow? 1. Fever with anemia and leukopenia, rare gametocytes (1 in 100 oil immersion fields) of Plasmodium falciparum in the peripheral blood smear (detected after the peripheral blood smear was reviewed in the …