Expert Opinion :
This child has presented with bicytopenia, bleeding manifestations and splenohepatomegaly and jaundice. Thus, one may consider a diagnosis of leukemia, histiocytosis and hemophagocytosis. Bone marrow does not show hemophagocytes, histiocytes or blast cells. Thus it is an evolving disease and diagnosis would become clearer as the disease progresses. The child on examination is found to have scrotal swelling. Since there is no ascites, it is unlikely to be hydrocele. Also in case of hernia, the swelling would be reducible unless it is an obstructed hernia. Thus, the scrotal swelling in such a scenario would imply testicular swelling. Presence of testicular swelling with above mentioned features suggests a diagnosis of leukemia and with myelofibrosis in previous bone marrow examination, one should consider a diagnosis of acute myeloid leukemia (AML). A repeat bone marrow examination in this child confirmed a diagnosis of AML. Thus not all pancytopenia with jaundice are histiocytosis or hemophagocytosis.