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A 77 year old male who is a known case of gastric Non Hodgkins lymphoma wich was a progressive Activated B-cell type of diffuse large B cell lymphoma treated with Rituximab and gemcitabine. Patient presented with persistent and recurrent fever despite on antibiotics. On clinical examination pallor was seen with no icterus and bleeding. No significant hepatosplenomegaly was noted clinically. His complete blood count showed Hb-8.2g/dl, Total leukocyte count-5880 cells/cumm and platelet-1lakhs 10 thousand.In view of persistent fever bone marrow examination including culture was done and sent.
Bone marrow aspiration cytology showed cellular marrow with prominent macrophages along with evidence of significant number of macrophages more than 5/hpf exhibiting hemophagocytosis with many showing platelets, neutrophils, erythroid cells and lymphocytes. Hence a diagnosis of secondary hemophagocytosis was given on the bone marrow aspirate cytology. His serum ferritin levels and triglycerides levels were checked after the aspirate diagnosis and was found to be elevated which met the criteria on clinical findings and labaratory criteria.