Hemophagocytic syndrome in a cat with Mycoplasma haemofelis infection

A six-year-old, castrated male domestic shorthair cat was presented for a week-long history of lethargy, acute anorexia, and adipsia. On presentation, the cat was weak with pale mucous membranes, open-mouth breathing, and mild popliteal lymphadenomegaly. Routine bloodwork revealed bicytopenia due to marked non-regenerative anemia and moderate thrombocytopenia; erythrocyte clumping was apparent on the blood smear, but no agglutination was noted on a saline dispersion test. Abdominal and thoracic imaging showed marked splenomegaly and multiple mildly enlarged lymph nodes. Aspirates from the bone marrow and spleen contained many erythrophagocytic macrophages and occasional lymphocytes containing engulfed erythrocytes. The macrophages also occasionally contained phagocytosed erythroid precursors, platelets, and leukocytes. A diagnosis of hemophagocytic syndrome was made based on the presence of bicytopenia and increased numbers of hemophagocytic macrophages in the spleen and bone marrow. Though no organisms were observed, Mycoplasma spp. infection was suspected and confirmed via PCR. To the authors' knowledge, this is the first report of a hemophagocytic syndrome in a cat with Mycoplasma haemofelis. Lymphocyte engulfment of erythrocytes has been previously reported in a cat with M. haemofelis infection. Both hemophagocytic syndrome and engulfment of erythrocytes by lymphocytes should prompt testing for Mycoplasma spp. even with a lack of evident parasitemia.