Marrow Fibrosis in Epstein-Barr Virus Infection, Masking Preleukaemic Phase of Acute Lymphoblastic Leukaemia: A Case Report

Preleukaemic phase of acute lymphoblastic leukaemia (ALL) is a rare occurrence that might affect children and adolescent. Typically, it is characterised by pancytopenia and bone marrow hypoplasia, followed by a leukaemic phase in peripheral circulation within 2 years’ time. We herein reported a case of marrow fibrosis in a 25-year-old patient with Epstein-Barr Virus (EBV) infection, whom presented with fever and incidental findings of pancytopenia. He was later found to have ALL when his peripheral blood findings showed neutropenia with presence of 59% blasts after 3 months of presentation. This case highlighted the importance of close monitoring of pancytopenia cases with non-specific findings in bone marrow examination. A repeat bone marrow examination should always be considered for cases with persistent unexplained pancytopenia, to allow early detection of overt ALL without delay.