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
- Environmental factors
The day of his haematology he is admitted with abdominal pain and the A&E doctor thinks he has marked heptomegaly.
- What imaging would you like?
- What viral tests are appropriate?
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