MYELOFIBROSIS IN VISCERAL LEISHMANIASIS

94 A 6-year-old male child presented with a 4-month history of increasing pallor, intermittent fever and abdominal distension. On examination, the patient was found to be moderately emaciated and pale with a markedly protruding abdomen. He had a few small ecchymotic spots over arms and legs and was afebrile at the time of examination. Systemic examination revealed an enlarged liver ( 3 cm) and a n enlarged spleen ( 1 0 cm). Both were firm and non-tender. Peripheral blood counts are shown in Table I . The peripheral blood film showed microcytosis, hypochromia and a few fragmented red cells. A bone marrow aspiration attempt from the posterior iliac crest repeatedly ended in a dry tap. A trephine biopsy was then done from the same site. Impression smears were made and the marrow tissue was processed for paraffin sections by routine methods. Sections were stained with haematoxylin-eosin (H&E). Giemsa and silver impregnation methods. Biopsy sections revealed a hypercellular marrow with increased numbers of fibroblasts. Megakaryocytes and macrophages were also increased. Numerous oval structures with a nucleus and kinetoplast (LD bodies) were seen both intraand extracellularly in H&E and Giemsa stained sections