[Splenomegalic pancytopenia of probable immune origin: cure after treatment with glucocorticoids]

Two female patients of 54 and 48 years, respectively, with pancytopenia and splenomegaly of probable immune origin are reported. The first presented anemic syndrome and fever, and the second bleeding. In both cases large sized splenomegaly was found on physical examination. Serologic and immunologic studies excluded chronic infection or systemic autoimmune disease. Bone marrow biopsy showed hematopoietic hyperplasia with lymphoid nodules and reticulin fibrosis. Treatment with glucocorticoids and splenectomy was performed in one case and only glucocorticoids were administered in the other case with the cytopenias disappearing and the bone marrow becoming normocellular. Reactive follicular hyperplasia was observed in the white pulp of the spleen in one of the patients, as were abundant macrophagic activity in the red pulp, and myeloid metaplasia. The patients remain asymptomatic at 4 and 12 years of follow up. The origin of the process was attributed probably to an immune etiology and differential diagnosis with idiopathic myelofibrosis and non tropical idiopathic splenomegaly must be considered.