Abstract
A 14-year-old boy was admitted because of the intractable nasal bleeding. He had been in excellent health until the admission. More than three months before the admission, he had been given indomethacin, sulpyrine, aminopyrine, ampicillin and midecamycin because of common cold. About one and a half months bfeore admission, he complained of general fatigue, palpitation and shortness of breath and he was noticed the icteric skin and sclerae at the time of admission. Physical examination on admission revealed icteric skin and sclerae, hepatosplenomegaly and multiple petechiae on the lower extremities. Liver function tests showed intrahepatic obstructive jaundice. The GOT was 742mU/ml, GPT 900mU/ml, LDH 300mU/ml, total bilirubin 6.3mg/dl (direct 5.0, indirect 1.3) and LAP 541 IU. Hematological examination showed sever pancytopenia. The RBC count was 273×104/mm3, Hb 8.1g/dl, Ht 23%, MCV 83μ3, MCH 29.3 μg, MCHC 35.3%, respectively. The WBC count was 900/mm3 with a normal differential count except for the presence of monocytoid atypical lymphocytes (3%). The platelet count was 4000/mm3. The bone marrow preparation revealed a severely aplastic and fatty marrow associated with an infiltration of vacuolated macrophages and reticulum cells which was considered to be characteristic to the hepatitis-aplastic anemia syndrome. The significance of vacuolated macrophages remians still to be clarified. The HBs antibody had been detected during his hospital days. Therefore, the present case might be probably aplastic anemia following acute hepatitis B. He developed the culture-negative sepsis and died of the intracranial hemrrhage and gastrointestinal bleeding. The clinical course from the onset of hepatitis was 20 weeks and the autopsy was not permitted.
