Jan 2020 Vol 10 issue 1
Dear friends and seniors,
I, on behalf of Lotus family wish you and your family a happy new year. May all your dreams come true and you find time to follow your passion. 2019 was a fruitful year as we completed an important milestone of 50 Bone marrow transplants (BMT) at Lotus Hospital . I wish to thank each one of you for reposing faith in me and my excellent transplant team without which I could not have achieved it. Our team of doctors, specialized transplant nurses, stem cell therapist work very hard during the entire process of BMT. I hope you continue your continued support and blessings to our endeavor to provide cost effective BMT to all the needy patients.
Case 1:
56 year old male was referred to me for persistent leukocytosis and anemia. The story started 2 months ago when he first had low grade fever and mild leukocytosis. He is a smoker (stopped 5 years ago). No DM. oral antibiotics were given.
His cbc showed leukocytosis (neutrophilia) and anemia. Platelets were normal. USG abdomen showed possible hepatic abscess (done twice). He was then treated for hepatic abscess for 4 weeks by gastroenterologists and physicians.
His low grade fever persisted and WBC count reached 42, 000 and hence he was referred to me by a physician who suspected something fishy?
His PBS showed neutrophilia with toxic granulations. He had microcytic anemia (iron deficiency due to poor diet which was put down due to multiple antibiotics.
USG done now showed no abscess but a diffuse infiltrative pattern in liver. CXR PA view showed ?mediastinal mass. He did not have leukemia or hematological malignancy. Fever continued. CRP was raised as was his ESR.
PET CT scan done revealed ??
Before turning the page do think of the differential diagnosis??
Final diagnosis: 1. Primary lung malignancy with metastasis to Liver and skeleton.
2. Reactive neutrophilia due to malignancy.
3. Anemia due to malignancy and poor diet due to malignancy.
Futher course:
He was referred to Onco surgeon for lung biopsy and then further treatment by a multidisciplinary oncology team.
Take home message:
1. Fever in any age is not always infective in origin.
2. Leucocytosis is not always due to infection.
3. Malignancy can cause fever and leukocytosis.
4. We should think of alternative diagnosis especially in elderly population.
5. We should discuss pathology and radiology reports with the concerned doctors (clinic-pathological meetings)
6. High degree of suspicion is needed for early diagnosis of Malignancy.
Laboratory news:
We have started inhouse tests like serum erythropoietin and soon we are starting immunofluorescence for ANA. We already do ANA blot assays.
Chief minister relief fund and various charities are associated with Lotus hospital to help patients with blood cancers, aplastic anemia, thalassemia and Bone marrow transplant.
Dr Pritesh S Junagade
MD (Medicine), MRCP(UK)
FRCPath (UK), CCST(UK)
Consultant Haematologist, Haemato-Oncologist and Bone Marrow Transplant Physician
