Case 25 – update 3

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.

Questions:

  • 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?

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.

TeamHaem are not a position of authority.  It is an educational platform to allow discussion

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Online education and discussion about all things haematological
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