Intrahepatocellular erythrocyte inclusions with hepatic sinusoidal infiltrates and splenomegaly.

We describe two patients suffering from a prolonged fever, pancytopenia, and splenomegaly. The spleen of both patients was grossly enlarged and the liver was moderately enlarged. The blood pictures were characterized by anemia and leukopenia to a severe degree, with moderate thrombocytopenia and moderate reticulocytosis. The serum transaminases were in the normal range, but the alkaline phosphatase was greatly increased. Splenectomy and wedge liver biopsies were performed on both patients. Histological findings of the spleen were variable. The histopathologic findings of the liver showed infiltration of lymphocytes, plasma cells, monocytes, and neutrophils into the dilated hepatic sinusoids. The sinusoidal infiltrate was more prominent in zones 1 and 2 and less prominent in zone 3 of the acinus. Erythrocyte inclusions that were confirmed by immunohistochemical methods were seen in the cytoplasm of hepatocytes. Electron microscopy revealed a penetration of erythrocytes into the cytoplasm of hepatocytes and caused leakage of cytoplasmic contents into Disse's spaces and sinusoids.