case_images: PMC9168658_01
case_images: Wright-Giemsa stain of bone marrow (x1,000). (A) Hemophagocytosis in bone marrow smear. (B-D) Large granular variant lymphocytes in bone marrow smear and the proportion was 6%.
case_images: fped-10-829927-g001.jpg
case_images: PMC9168658_01_fped-10-829927-g001.jpg
case_images: F1
case_images: Hemophagocytosis and large granular variant lymphocytes were scattered seen in bone marrow smear, and the proportion of large granular variant lymphocytes was 6% (Figure 1).
case_images: The flow cytometry detection of bone marrow revealed CD3-CD56+ cells counted for 55.67% of the lymphocytes, with HLA-DR+, CD2+, CD7 (dim)+, CD16+, CD38+, CD56+, and CD3-.
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case_images: PMC9168658_01_fped-10-829927-g002.jpg
case_images: F2
case_images: CD3-CD56+ cells counted for 55.67% of the lymphocytes, with HLA-DR+, CD2+, CD7 (dim)+, CD16+, CD38+, CD56+, and CD3- (Figure 2). Chromosome karyotype analysis found 46, XX, t (6;9) (q23; p24).
case_images: Axial magnetic resonance imaging of the brain in this ANKL patient. Axial T2-weighted (1B-3B) and fluid-attenuated inversion recovery (1C-3C) of brain showing white matter high signal at bilateral centrum ovale, periventricular areas, basal ganglia areas and pontine. Axial T1-weighted (2A) imaging and diffusion-weighted imaging (2D) shows high signal at areas of putamen and caudate nucleus head.
case_images: fped-10-829927-g003.jpg
case_images: PMC9168658_01_fped-10-829927-g003.jpg
case_images: F3
case_images: Axial T1-weighted imaging and diffusion-weighted imaging showed high signal at areas of putamen and caudate nucleus head (Figure 3).
case_images: Typical laboratory indexes of blood and the drugs used for the patient from day of admitting, she died 55 days later. LDH, lactic dehydrogenase; ALY, atypical lymphocyte; WBC, white blood cell; DDI, D-Dimer; DEX, dexamethasone; MP, methylprednisolone; VP16, etoposide; DOX-lip, doxorubicin liposomes; L-Asp, L-asparaginase; BTZ, bortezomib.
case_images: fped-10-829927-g004.jpg
case_images: PMC9168658_01_fped-10-829927-g004.jpg
case_images: F4
case_images: Ultimately this patient deceased due to lethal hemorrhagic complications: pneumorrhagia and gastrointestinal bleeding (Figure 4).