Case 38 – update 1

So what have we found out?
We have a 32 year old male patient who has come back from a 2 year ’round the world’ trip 4/52 ago. He has travelled to Russia, China, India, Argentina, Kenya, Tanzania, Australia, Thailand and Indonesia.
While travelling he has had a few episodes of travellers diarrhoea which have been associated with temperatures. He has received antibiotics for these.
Whilst travelling he has has several relationships with women, none of whom he is in contact with now.
Over the last 3/52 he has had sweats fever and 3/4 stone weight loss. He has also got some abdominal discomfort and on examination has an enlarged spleen and a large LIF mass. There are also a few 1cm groin nodes.
Bloods reveal

Hb 125

Plt 50

Wcc 4.02

Neut 2.01
Pt 14

Aptt 30

Fib 6.7
Creat 102, urea 6.7

LFT normal

Crp 50
We have also done infection screens

Malaria screening kit negative, with no parasites seen on thick or thin films.

Hepatitis b,c negative

HTLV negative

EBV IgG positive, IgM negative
We have had the blood film back

There is thrombocytopenia, with morphologically normal PLT. No fragments. There are several nucleated red cells seen. There is some left shift of neutrophils, with occasional myelocytes seen. There are also one or 2 large very basophilic lymphocytes seen.
LDH is 9050
The HIV test is also back and is found to be positive.
A ct scan of the chest/abdo/pelvis has been urgently requested and a biopsy of the mass has been requested.
What would you like to do next? are other tests indicated? Are there any other infection screens you would like to do?

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