For start of case see below (or click https://teamhaem.wordpress.com/2014/09/07/case-25-the-beginning/)
Bearing in mind the below differential diagnoses #teamhaem have requested a number of investigations:
- HIV – negative
- EBV – serology is consistent with past infection
- CBV – serology is consistent with past infection
- Hepatitis B and C – negative
- LDH – 526 (100-250)
- B12 and folate – within reference ranges
- Autoimmune screen – negative
- Ferritin 725; transferrin saturation 16%
- ALP 325, ALT 65, bili 17, albumin 31
- Immunoglobulins: polyclonal rise in IgA
A CT chest abdomen and pelvis following the administration of intravenous contrast shows a left basal pneumonia. Hepatomegaly. Previous splenectomy. Shotty lymphadenopathy in the abdomen and pelvis and inguinal regions betweel 5 and 10mm. The abdominal vessles appear patent. There is a mild coagulopathy with a DIC type picture.
- A bone marrow aspirate has been mentioned by #teamhaem. Is there any other sources of tissue that may help?
- He has traveled in the Mediterranean and India for work in the past six months. Does this change the differential?
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