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Iran was admitted to the hospital because of a fever of three months' duration, which was not associated with chills or . sweating. Twenty days later a dry cough was also noted. There were episodes of epistaxis and nonbloody diarrhea. Fever and cough persisted in spite of various medications.Her developmental milestones were slightly delayed. She was of a poor socioeconomic background and had poor nutrition.Physical examination on admission showed an underdeveloped, undernourished chronically illlooking child who had tachypnea and epistaxis. Her pulse rate was 120/min, respiratory rate 32/min, height 90.0 cm, weight 11.0 kg, blood pressure 90/50. Skin and mucous membranes were pale. There was puffiness of the face and bleeding from both nostrils. She had mild glossitis. Neck veins were engorged. Postauricular lymphadenopathy was present. Intercostal and substernal retractions were evident. Breath sounds were harsh and moist rales were audible all over the chest.There was a pericardial heave. S1 and S2 were increased. A functional apical systolic murmur was heard. The abdomen was distended, and superficial abdominal veins dilated. The spleen was tender and markedly enlarged, down to the iliac crest. Liver was palpable 4 cm below the right costal margin. There was no ascites. Edema of all extremities was detectable. Hemoglobin level was 5 gm, and the white blood count °4 ,700 (differential: 21 seg, two bands, two metamyelocytes, two normoblasts). Direct smear showed hypochromia anisocytosis, and poikilocytosis.