Özet:

Background: Hemophagocytic syndrome is a reactive disorder of the mononuclear phagocytic system. The association of pancytopenia in severe malaria due to Plasmodium vivax with hemophagocytic syndrome is extremely rare and very few cases are reported in the world literature. Aim: The study was undertaken to establish P. vivax infestation associated with hemophagocytosis in bone marrow as one of the causes of chronic pancytopenia/bicytopenia with fever and splenomegaly in endemic areas. Materials and Methods: Prospective study of 110 patients of different age groups presenting with chronic fever with pancytopenia or bicytopenia from January 2015 to November 2017 was carried out. 49 patients showed the presence of P. vivax trophozoites in bone marrow. Among these 11 patients showed the presence of hemophagocytosis in bone marrow fulfilling 6 out of 8 criteria of diagnosing hemophagocytic lymphohistiocytosis according to 2004 criteria. Results: The age of patients varied from 8 years to 54 years. 11 Cases showed the presence of P. vivax trophozoites with the presence of hemophagocytosis in bone marrow showing, hyperplastic marrow showing normoblastic and megaloblastic hyperplasia. Conclusion: Hemophagocytic syndrome in malaria should be suspected in all cases of chronic fever with pancytopenia or bicytopenia, splenomegaly. Bone marrow aspiration is recommended to confirm the diagnosis of P. vivax as one of the causes of the secondary hemophagocytic syndrome in malaria-endemic areas.

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