Is Identification of Lupus Erythematosus Cells Still Useful? A Case Report

Abstract

A 13-year-old girl presented with significant weight loss, depression, anemia, and neutropenia. The preliminary diagnosis was anorexia nervosa combined with depression. Due to peripheral cytopenia, a bone marrow biopsy was performed to rule out leukemia. Lupus erythematosus (LE) cells were found in the bone marrow aspirate, which prompted autoantibody testing, although clinically it was not suspected the patient had systemic lupus erythematosus (SLE). Further testing demonstrated very high levels of antinuclear antibodies (ANA) (>12 U) and anti-double strand DNA (dsNDA) (>1000 IU/mL), which confirmed the diagnosis of SLE. The patient was treated with steroids for SLE, and symptoms improved quickly. In conclusion, although the identification of LE cells as one of the diagnostic criteria for SLE has been obsolete, careful examination of bone marrow to identify LE cells is still very important in the diagnosis of unsuspected SLE.

Hematoxylin Bodies in Pediatric Bone Marrow Aspirates and their Utility in the Diagnosis of Systemic Lupus Erythematosus

“…Review of the 15 pediatric SLE bone marrow aspirates revealed LE cells in only 1 patient (P1), the index case in the previous case report. 14 However, hematoxylin bodies were present in the bone marrow aspirates of 8 patients (P1–P8) (8/15, 53%). As shown in Figure 1(A) and (B), hematoxylin bodies in the bone marrow aspirates with Wright–Giemsa stain appear as magenta to purple, dense, homogeneous round or oval bodies with a size of 0.5 to 1.5 times that of neutrophils.…”

“…However, the finding of LE cells in bone marrow and body fluids in previous reports has prompted the testing of autoantibodies and resulted in the diagnosis of unexpected SLE. 8–13 In our recent case report, 14 LE cells were identified in the bone marrow aspirate of an adolescent girl who was thought to have anorexia nervosa and depression. The bone marrow biopsy was performed to rule out leukemia, suspected due to anemia and neutropenia.…”

“…Composed of both DNA (basophilic) and protein (eosinophilic), these hematoxylin bodies found in peripheral blood or bone marrow aspirate smears stained with Wright stain are equivalent to those ''hematoxylin bodies'' found in hematoxylin and eosin-stained tissue sections of lymph node, kidney, and skin in the SLE patients. 17 In light of the recent case report, 14 we reviewed a series of bone marrow aspirates from patients with known SLE to determine whether LE cells and/or hematoxylin bodies are present in the aspirates. In our practice, only a minority of patients with SLE have bone marrow biopsies performed.…”

“…In light of the recent case report, 14 we reviewed a series of bone marrow aspirates from patients with known SLE to determine whether LE cells and/or hematoxylin bodies are present in the aspirates. In our practice, only a minority of patients with SLE have bone marrow biopsies performed.…”

Occasional detection of lupus erythematosus cells in bone marrow samples: A case report

“…2 Hematoxylin bodies are engulfed by neutrophils, resulting in the formation of LE cells. 2,3 In cytological preparations, LE cells must be distinguished from "tart cells" or "pseudo-LE cells," which result from the phagocytosis of nuclear debris by macrophages rather than neutrophils and are generally observed in effusion fluid. 3 The phagocytosed debris within a tart cell is smaller and has a nonhomogeneous (clumped) appearance in contrast to the smooth, homogeneous nature of hematoxylin bodies in true LE cells.…”