History of fever, pallor and evidence of petechiae is s/o bone marrow depression. which could be secondary to malignancy or aplastic crisis (idiopathic or infection induced ). But the presence of hepatomegaly, spleenomegaly and lymphadenopathy goes more in favor of malignancy. A viral infection may also produce a similiar picture.The picture can be clarified with a detailed investigations as
1.periphral smear
2.bone marrow asp. and biopsy
3.Hb F for JCML
4.XR Chest for mediastinal masses
JCML seems to fit in the picture in view if age group, hepatospleenomegaly with lymhadenopathy, seborrhoic rash and monocytosis on the differential count. Other possiblities could be NHL, Leukaemia or Histocytosis.
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