The patient tells you that he has been feeling increasingly unwell for the last few weeks. He describes fatigue, headache and low grade fever over the last two weeks and put it down to a cold. On closer questioning he thinks he admits he has lost some weight, although he assumed this was due to a lack of appetite. Examination does not reveal organomegaly, but he does have a couple of palpable nodes in his groin. On oral examination you note some tonsillar enlargement and pharyngeal erythema. You can’t find a fundoscope, but he has no focal neurology of note.
On review of results you discern the following:
- Normal FBC until 3 weeks ago
- CRP 88
- U&E normal
- ALT risen in last month, currently 134; liver team have adjusted tacrolimus in response
- EBV PCR 6.8 x 10 7
- Viral hepatitis repeat screens negative
- CMV and parvovirus PCR negative
What is your differential diagnosis now? Wpuld you image and what might it show?
Please remember to include #teamhaem hashtag in your response on twitter. More to come tomorrow….