Photoclinic Diagnosis: Hemophagocytic Syndrome — Presentation with Midline Palatal Lesion

A37-year-old woman was admitted to a hospital in Tehran, Iran, with malaise, weakness, fever, weight loss and jaundice of more than 1 month.s duration. Physical examination revealed hepatosplenomegaly and an enlarged submandibular lymph node (1 x 1 cm). The laboratory findings are presented in Table 1. Biopsy results were compatible with necrotizing immunologic lymphadenitis in cervical lymph node, and megaloblastoid maturation and normal cellularity in the bone marrow. The patient symptoms deteriorated with time. Palatal ulceration and muscle weakness added to the clinical picture, and she sought medical attention 1 month later because of continuous fever, jaundice, hepatosplenomegaly and midpalate necrotic ulcer, and was referred to another hospital.