Case 25 – update 2

You have a patient awaiting a two week wait appointment for weight loss, fever and pancytopenia. He is rather obese so examination is difficult.  He has a history of diffuse large B cell non-Hodgkin lymphoma treated to complete remission ten years ago and splenectomy.

Differential diagnosis includes:

  • B12 and folate deficiency
  • Therapy-related myeloid neoplasm (encompassing secondary myelodysplasia and secondary acute myeloid leukaemia as a result of previous chemotherapy)
  • Bone marrow infiltration due to malignancy, including relapse of his original lymphoma
  • Viral infection/sepsis, including HIV
  • Haemophagocytic lymphohistiocytosis
  • Autoimmune
  • Chemical/medication
  • Environmental factors

The day of his haematology he is admitted with abdominal pain and the A&E doctor thinks he has marked heptomegaly.

Questions:

  • What imaging would you like?
  • What viral tests are appropriate?

Please reply on Twitter and always include #teamhaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to  evolve over the coming week so keep checking #teamhaem for more information.

Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality.

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