Vitiligo, progressive weight loss, hair loss, fever | Figure 1

Case Summary

Patient: Female, 12 years old
Presentation: Developed vitiligo for 1.5 years. Over the last 6 months, she experienced weight loss, hair loss, loss of appetite, and low-grade fever (more at night, without chills or night sweating, relieved by antipyretics). Also developed arthralgia and pallor over the last month.

By Examination

• Cachexia
• Severe wasting
• Pallor
• Vitiligo
• Right epitrochlear and bilateral cervical lymph nodes
• Mild hepatomegaly

By Investigation

• Normocytic normochromic anemia
• Reticulocyte index: 0.8
• Positive Coombs test
• ESR: 128/128
• LDH: 1005
• Viral serology: Negative
• Immunoglobulins: Normal

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