Image Challenge #4

A 15-year-old female presented with a high-grade fever. Her complete blood count and blood film revealed  pancytopenia and presence of atypical lymphocytes respectively. Level of serum ferritin was 540 ng/ml and Epstein-Barr virus antibody (IgM) was positive.

What is the most likely diagnosis?

Presented by Dr. Dhulfiqar A. Arab, MBChB, FIBMS hematopathology, Al-Najaf Teaching Hospital, Najaf, Iraq

Answer: Haemophagocytic lymphohistiocytosis