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A 10-year-old child was evaluated for pancytopenia. Peripheral blood smear examination showed a microfilaria larva at the edge (Wright-Giemsa stain, ×40). The larva was readily identified by its elongated, slender, sheathed morphology with a curved body and characteristic tapered tail. Microfilariae are most commonly detected in peripheral blood in lymphatic filariasis, especially in appropriately timed blood specimens. Although usually asymptomatic, rare cases have described an association between filariasis and pancytopenia. A published pediatric case similarly reported pancytopenia in a child in whom microfilariae were identified on a nocturnally collected peripheral blood smear, with subsequent improvement in blood counts following antifilarial therapy [1]. In a child presenting with otherwise unexplained pancytopenia, careful examination of the peripheral smear can therefore reveal an unexpected infectious etiology or associated finding, emphasising the continuing diagnostic value of meticulous smear examination, especially the cutting edge.

Reference:

1.  Mandal AK, Jana JK, Gayen S, Pal AC. Filariasis presenting as pancytopenia in a child. BMJ Case Rep. 2022;15(5):e248930