[Severe pancytopenic episodes in two cases with mosquito-allergy]

Two young females were admitted one by one because of peculiar skin eruptions suggesting mosquito-allergy and severe pancytopenia with normo-hypercellular bone marrow. The outcome of the first case was fatal on account of severe pancytopenia, immune deficiency and marked jaundice 14 months after the initial pancytopenic episode. In the post-mortem examination, HMR (histiocytic medullary reticulosis) was highly suggestive since hepatosplenomegaly with increase of Kupffer cells and large histiocytes including some atypical cells were detected. The second patient was treated with splenectomy because the past treatment were unsatisfactory in the first case and another cases in literatures. After the operation, the patient sustained almost normal blood cell level for 11 months without any treatment. As for the histopathological findings of resected spleen and lymphnodes, some erythrophagocytic mature histiocytes were found, but no atypical cells was detected. The relationship with pancytopenia, mosquito-allergy and HMR was discussed on the two cases and literatures.