So our young woman is in A&E/ED. We have established the following:
She has been a little tired and anorexic lately.
She had a sore throat 2 weeks ago and received amoxicillin. She only took the pills for 4 days as she developed a rash.
She has attended with dyspnoea but no cough or sputum.
Obs: temp 39, BP 95/60 HR 118, RR 20 Sats 97%.
Exam: chest clear, cervical nodes bilaterally but nil elsewhere; no organomegaly.
Bloods: hb 78, MCV 104, plts 11, wcc 2.1 with neuts of 0.1. Retics 0.1
Film shows atypical lymphocytes with abundant basophilic cytoplasm.
CXR: no consolidation.
Further history: she states she drinks less than 30 units of alcohol per week. She is not pregnant. She hasn’t taken any other medication and has no joint, eye or skin abnormalities (other than the truncal macpap rash which has now resolved).
We’ve agreed that she needs broad spectrum antibiotics and fluids and close attention to sepsis management.
What is going on?
A lot of you are wondering about the patient’s EBV CMV HIV status.
Some mutterings have been heard about haemophagocytosis and other uber-rare disorders.
Leukaemia has also been suggested.
What do you think? What is our next test?
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