[Clinical Picture] Pancytopenia associated with bone marrow infiltration from late relapse of neuroblastoma

A 30-year-old woman presented to Rhode Island Hospital in October, 2022, with 3 days of fatigue and fevers, and found to be in circulatory shock. 28 years before, she had been treated for high-risk neuroblastoma that had metastasised to the bone treated per the 34-DAT protocol with induction chemotherapy, right adrenalectomy, tandem autologous haematopoietic stem-cell transplants, and total body irradiation and had responded. Laboratory investigation showed pancytopenia (absolute neutrophil count 0 cells per μL, haemoglobin 9·6 g/dL, platelets 17 000 cells per μL) and elevated aspartate aminotransferase (1614 IU/L), ferritin (>16 500 ng/mL), triglycerides (464 mg/dL), fibrinogen (495 mg/dL), and soluble IL-2R (9509·6 pg/mL).