Thursday, September 8, 2011

Don't Treat a Number

A patient (usually seen in children, but described in adults) presents with fever, hepatomegaly, splenomegaly, nonspecific rash, lymphadenopathy, and neurologic symptoms. Labs show cytopenia in two cell lines, high triglycerides, low fibrinogen, elevated liver enzymes, and decreased coagulation factors.

Challenge: Everything above is pretty nonspecific, but what if the patient had a ferritin level of 20,000 micrograms/liter? What would your leading diagnosis be?

Image shown under Fair Use.


Anonymous said...

Most likely hemophagocytic lymphohistiocytosis.
Ddx also includes Still's disease.

Craig Chen said...

Wow, that's perfectly right! Not an easy case...
Don’t Just Treat a Number

This is hemophagocytic lymphohistiocytosis (which also has many other names). The image shows a bone marrow biopsy with reactive histiocytes phagocytosing nucleated red cells (red arrow) and platelets (black arrow).

Source: UpToDate.