Medical Mystery of the Week
You have recieved your COVID19 immunizations and have returned to your in-patient
and out-patient medical practice.
Your patient is a 64-year-old woman from New England with a past history of relapsing-remitting multiple sclerosis who was referred to you because of intermittent nausea and fatigue of seven months duration. A CT scan of her abdomen done 5 months before your exam revealed cholelithiasis and splenomegaly and blood work done at that time revealed a normochromic normocytic anemia and thrombocytopenia with a hemoglobin of 8.3 g/dl, a hematocrit of 26.1%, and a platelet count of 95,000 per uL. Her reticulocyte count was 4.6%, ferritin 1,248 ug/L, CRP 144.7 mg/L, and haptoglobin <14 mg/dL.
Her symptoms and laboratory abnormalities had failed to respond to an empirical course of prednisone and she developed intermittet fever with worsening of her nausea and fatigue.
Your exam reveals a chronically ill appearing woman with a temperature of 38.3°C, a BP of 90/54 mm Hg, a respiratory rate of 19 breaths per minute and a regular pulse rate of 93 beats per minute. Her BMI is 32.2. Positive findings include conjunctival pallor, splenomegaly, and leg edema.
The results of a contrast enhanced CT scan and a 18F-fluorodeoxyglucose scan of the chest, abdomen and pelvis are shown in panels A and B below, respectively.
What is your diagnosis, what test(s) would you order to confirm your suspicions, and what treatment, if any, do you recommend?
To receive credit, please email your answers to email@example.com