Case report
Pure Red Cell Aplasia with Triple Pulmonary Co-infection and Shock-induced Organ Injury: An Autopsy-based Case Report
ED10-ED13
Correspondence
Dr. Aravind Sekar,
Associate Professor, Department of Histopathology, PGIMER, Chandigarh-160012, India.
E-mail: nez3893@gmail.com
Pure Red Cell Aplasia (PRCA) is a rare haematological disorder characterised by profound anaemia, reticulocytopaenia, and selective erythroid precursor depletion. While immunosuppressive treatment is a cornerstone of management, it significantly increases patient susceptibility to life-threatening opportunistic pathogens. The authors present the case of a 26-year-old male with PRCA and hypogammaglobulinaemia who presented with rapidly progressive respiratory failure. Despite intensive care, the patient succumbed within five days of admission. Bone marrow examination revealed marked erythroblastopenia and moderate hypocellularity. Post-mortem examination identified Diffuse Alveolar Damage (DAD) resulting from a concurrent pulmonary triple co-infection: Pneumocystis jirovecii (P. jirovecii), Mycobacterium tuberculosis (M. tuberculosis), and Cytomegalovirus (CMV). These findings were confirmed via specialised stains and Immunohistochemistry (IHC). Systemic findings included centrilobular hepatic necrosis and acute tubular injury, consistent with terminal cardiovascular collapse. The present case underscores the extreme vulnerability of immunocompromised individuals and highlights the necessity of aggressive surveillance, the consideration of polymicrobial involvement in deteriorating patients, and the potential role of expanded prophylaxis to reduce mortality in this high-risk population.