A 52-Year-Old Man With Fatigue, Leukocytosis, and Moderate Splenomegaly

Koyamangalath Krishnan, MD


December 11, 2017

Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 52-year-old man presents to the emergency department with generalized fatigue and weakness over the past couple of months. He explains that the symptoms are becoming progressively worse, with decreased exercise tolerance. He also reports night sweats and a 20-lb weight loss over the past 6 months. He describes a dull heaviness in abdomen on the left side and early satiety. He denies having cough, chest pain, nausea, vomiting, headaches, dysphagia, rashes, lumps, hemoptysis, hematuria, or blood in stools.

The patient's bowel and bladder habits are normal. His medical history is unremarkable other than hypertension. He has had no surgeries in the past. He has a 15-pack-year smoking history but quit 10 years ago. He drinks occasional wine and denies illicit drug use. His home medications include lisinopril and acetaminophen as needed.


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