Microfilaria Causing Bone Marrow Failure

Abstract

It is common to detect microfilariae in various cytological preparations, however there are very few case reports describing microfilariae in bone marrow aspirates. It is rarer to get bone marrow failure secondary to microfilaria in bone marrow. We report here a patient from Bihar, presented to us with prolonged fever and pancytopenia, bone marrow aspirate showed microfilaria. Treatment with DEC and albendazole resulted in prompt recovery. Our patient is a 26 year old male, from Patna, Bihar now working in footware factory, in Kerala, presented with fever, headache and vomiting for 6 days. Fever was high grade, remittent with chills and rigor and headache was bifrontal, moderate in severity. He had occasional vomiting which was not projectile. There was no history of dysuria, respiratory or abdominal symptoms. There was no history of any bleeding manifestations. There was no significant illness in the past. He was addicted to tobacco chewing, was unmarried and there was no history of any high risk behavior. On examination, he was conscious, oriented, moderately built and nourished. He was febrile with stable vital signs. There was pallor, no icterus, clubbing or lymphadenopathy. Abdomen examination showed mild hepatosplenomegaly which was firm and non tender, without any free fluid. All other systems were within normal limits. Case ReportFigure1: Bone marrow aspirate showing microfilaria Investigations showed hemoglobin 9 g%, total count 1200/µl differential count P40L40, MCV 77.3fl, platelet count 65000/µl. His liver, renal function tests, serum electrolytes, blood sugar were within normal limits. Initially a possibility of malaria was considered and patient was started on chloroquine and primaquine without any response as fever persisted. Peripheral smear for malaria parasites was repeatedly negative. Artesunate and Doxycycline was added considering falciparum malaria, but fever was persisting. Meanwhile his total count dropped to 700/µl and hemoglobin dropped to 6.5 g%. Suspecting underlying bone marrow failure, bone marrow aspirate was done which showed microfilaria ( Figure -1,2) and the cellularity was decreased, reported as ? hypoplastic.