We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Special Feature |

Pathological Case of the Month FREE

Nandita Kakkar, MD; R. K. Vasishta, MD, FRCPath; Neelam Marwaha, MD; R. K. Marwaha, MD
[+] Author Affiliations

Section Editor: Enid Gilbert-barness, MD

Arch Pediatr Adolesc Med. 2001;155(5):611-612. doi:10.1001/archpedi.155.5.611.
Text Size: A A A
Published online

A 3-MONTH-OLD BOY was seen for pallor and oily stools. Findings revealed a hemoglobin level of 46 g/L; platelet count, 442 × 109/L; and total lymphocyte count (TLC), 4.6 × 109/L with polymorphs at 0.26 × 109/L; lymphocytes, 0.72 × 109/L; and monocytes, 0.02 × 109/L. Moderate anisocytosis, mild poikilocytosis, hypochromia, microcytes, macrocytes, and teardrop and crenated cells were seen on peripheral blood film. Stool fat estimation at age 5 months was 14.75 g in a 3-day collection. Results of a sweat chloride test were normal. He was treated with oral iron and folic acid preparations and pancreatic enzymes and given 1 blood transfusion; his hemoglobin level improved initially (91 g/L). The TLC and absolute neutrophil count decreased, and at age 5 months the TLC was 1.8 × 109/L with an absolute neutrophil count of 0.36 × 109/L. The child had repeated infections with loose oily stools and diarrhea for 2 years and 9 months. He developed septic shock and died at age 3 years, at which time hemoglobin levels were 82 g/L with decreased platelet count, and the TLC was 1 × 109/L. A blood culture grew Pseudomonas aeruginosa. Cut section of the pancreas revealed loss of normal pancreatic architecture (Figure 1). Microscopy shows the bulk of the pancreatic tissue replaced by fatty tissue (Figure 2). Pancreatic ducts are preserved, and islets of Langerhans are relatively prominent and composed of large cells (Figure 3). Atrophic and shrunken acinar tissue is seen with cells having a pink cytoplasm and pyknotic nuclei (Figure 4). A section of bone marrow showed maturation arrest of the myeloid series of cells with normal erythroid and megakaryocytic series.




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

2 Citations

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections