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 74-year-old man presents with easy bruising, fatigue, and generalized weakness. The patient's symptoms have been progressing during the past 3 weeks. He denies having any other symptoms. The patient has no significant past medical history and denies any recent travel, tobacco use, or use of illicit drugs. The patient is retired from an office administration position.
He is admitted to the hospital for evaluation of his weakness and easy bruising. On admission, a chest radiograph is obtained but no abnormalities are noted. An initial complete blood cell count is ordered, which shows thrombocytopenia, with a platelet count of 12.0 × 103/μL (12.0 × 109/L), and anemia, with a hemoglobin of 6.8 g/dL (68 g/L) and a hematocrit of 19% (0.19). His peripheral blood smear demonstrates 12% blasts.
The patient undergoes a subsequent bone marrow biopsy, which confirms acute myelocytic leukemia. He then receives induction chemotherapy with cytarabine and daunorubicin. Following induction, the patient becomes pancytopenic, with a 21-day bone marrow biopsy showing chemotherapeutic effect. The patient's hospital course is then complicated by febrile neutropenia and vancomycin-resistant Enterococcus bacteremia from a central venous catheter infection. He is treated with intravenous linezolid, which clears his bacteremia based on repeat blood cultures; however, he still suffers persistent fevers.
On day 30 post-induction, the patient develops shortness of breath and complains of a progressive, nonproductive cough.
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Cite this: Arunabh Talwar, Craig E. Devoe, Nick Patel. A 74-Year-Old Man With Easy Bruising and Fatigue - Medscape - Feb 09, 2017.