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Flaviviruses and Bone Marrow Failure

Neal S. Young, MD
JAMA. 1990;263(22):3065-3068. doi:10.1001/jama.1990.03440220089037.
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SELECTED CASE  IN MARCH 1989, a 21-year-old army private was transferred to the Clinical Center for treatment of aplastic anemia. He had been well until October 1988, when he had a serologically documented episode of hepatitis B; symptoms of malaise and lethargy persisted until January 1989, when he developed nose bleeds, gum oozing, and easy bruising. In early February 1989, peripheral blood cell counts were obtained: hematocrit, 0.18; leukocyte count, 1.1×109/L; and platelet count, 8 × 109/L. A bone marrow was acellular. Fever developed, and administration of antibiotics was begun empirically. He was transferred from his base in Italy to Walter Reed Army Medical Center, Washington, DC, where serological studies revealed antibodies to hepatitis B core and surface antigens and to hepatitis A but no hepatitis B core antigen or IgM antibody to core antigen. Administration of antibiotics was discontinued without recurrence of fever, and he

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