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. 2026 Jul 13;17:1880997. doi: 10.3389/fphar.2026.1880997

FIGURE 7.

Two line graphs compare monocyte count changes over time in twins labeled A and B. Twin A shows a sharp increase in monocyte count near day 12, marked with a red arrow and labeled "Death." Twin B displays varied monocyte counts with blue arrows indicating bone marrow aspiration, etoposide treatment, and CSF analysis, ending with a decline at day 45, marked "Death" with a red arrow.

Time-Course of Monocyte Counts and Clinical Interventions in Twin Infants with IEM. The graphs illustrate the temporal changes in absolute monocyte counts (×103/μL) during the intensive care follow-up period in Twin A (left) and Twin B (right). Twin A demonstrated a progressive rise in monocyte count, peaking at 4.77 × 103/μL on day 10, followed by rapid clinical deterioration and death before treatment could be initiated. Twin B underwent bone marrow aspiration on day 12, confirming macrophage activation syndrome. Etoposide therapy was initiated shortly thereafter; although the monocyte count increased to 2.58 × 103/μL on day 24, it subsequently showed a gradual decline. Subsequent cerebrospinal fluid (CSF) analysis revealed monocyte infiltration, preceding neurological deterioration and eventual death on day 44. Arrows indicate key clinical events: bone marrow aspiration, initiation of etoposide therapy, CSF analysis, and time of death.