To the Editor.—
Dr Shreiner's article (231:838, 1975) suggests a stem-cell abnormality as the possible underlying cause of the patient's acute lymphoblastic leukemia and subsequent histiocytic medullary reticulosis. Further thought on the cause of the latter disease is provoked by the existence of 25 cases of histiocytic medullary reticulosis seen at Mulago Hospital in Uganda over a seven-year period.1-2Good American articles often fail to note the existence of this large number of cases.3 Serck-Hansen and Purchit have postulated that the increased incidence of cases in the tropics may be due to increased stimulation of the reticuloendothelial system, resulting from frequent infections or from malnutrition beginning in early infancy.1 It may be of additional interest that many of these cases come from the same area where there is an increased incidence of Burkitt lymphoma.
Marvin RF. Acute Lymphoblastic Leukemia And Histiocytic Medullary Reticulocytosis. JAMA. 1975;233(12):1258. doi:10.1001/jama.1975.03260120020005