Oxalate Crystals In Bone Marrow - A Rare Pathological Insight - Pancytopenia Presenting With Fungal Septicemia In A Patient With Undiagnosed Primary Hyperoxaluria.
PANCYTOPENIA PRESENTING WITH FUNGAL SEPTICEMIA IN A PATIENT WITH UNDIAGNOSED PRIMARY HYPEROXALURIA.
Abstract
Primary hyperoxaluria type 2 (PH2) is a rare autosomal recessive metabolic disorder that can lead to systemic oxalate deposition, particularly in advanced stages. Bone marrow involvement is uncommon and rarely causes clinically significant pancytopenia, though it may increase vulnerability to severe infections in patients with end-stage renal disease (ESRD) on dialysis.
We present a case of a 35-year-old male with PH2 and ESRD who developed fever and pancytopenia. Blood cultures grew Candida parapsilosis, and echocardiography revealed aortic valve vegetation, confirming fungal endocarditis. Bone marrow biopsy showed extensive oxalate crystal deposition replacing hematopoietic tissue. Despite antifungal treatment and catheter removal, the patient suffered an embolic stroke and died.
Bone marrow crystal deposition should be considered in PH2 patients presenting with unexplained pancytopenia. This rare complication can predispose to life-threatening infections, emphasizing the need for timely diagnosis and multidisciplinary management.
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