Acquired Immune Deficiency Syndrome and Pancytopenia

A patient with the acquired immune deficiency syndrome experienced pancytopenia during the course of his illness. At the time of maximum depression of the blood cell counts, the hematocrit value was 21%; the WBC count, 1,000/cu mm; and the platelet count, 27,000/cu mm. Lymphopenia was persistent but the number of juvenile neutrophils was not diminished. Peripheral blood smears were noteworthy for the presence of atypical monocytes with phagocytic vacuoles. Histiocytic hemophagocytophagia was prominent in bone marrow aspirate specimens. Bone marrow biopsy specimens were usually hypocellular and contained collections of atypical lymphocytes and increased reticulin. These hematologic abnormalities are most likely the consequence of persistent viral infection in an immunocompromised host.