Bone Marrow Necrosis in a Child With Sepsis-Induced Macrophage Activation Syndrome

Bone marrow necrosis (BMN) is a rare condition, mostly described with hematological malignancies. Association of BMN with sepsis-induced macrophage activation syndrome (MAS) is rarely reported in the literature. Recently, we managed a 10-year-old girl with Staphylococcus aureus sepsis and MAS who had extensive BMN. Patient initially improved with antibiotics, source control, supportive care and immunomodulatory therapies (intravenous immunoglobulin and methylprednisolone). However, she succumbed to transfusion-related acute lung injury. Sepsis, MAS and BMN seem to represent increasing levels of immune dysregulation, hypercytokinemia and hyperinflammation. Int J Clin Pediatr. 2020;000(000):000-000 doi: https://doi.org/10.14740/ijcp346