![]() The temperature was 38☌, the pulse was 100, and the respirations were 20. There was no history of tobacco or alcohol abuse, shaking chills, or use of intravenous drugs or other risk factors for infection with the human immunodeficiency virus (HIV). He was a part-time cashier and attended school. He had had repeated bouts of malaria during childhood but had otherwise been well. The patient was a native of Nigeria who had immigrated to this country nine years before admission and had not returned to his homeland. The patient was admitted to the hospital. Microscopical examination of thick and thin blood smears showed no malarial parasites. Microscopical examination of an aspirated bone marrow specimen showed marked trilineage hematopoiesis. A magnetic resonance imaging (MRI) examination of the right arm ( Figure 3) showed an abnormal signal in the medulla of the humerus, a finding consistent with regenerating marrow. A CT scan of the abdomen and pelvis ( Figure 2) revealed hepatosplenomegaly and lymphadenopathy, principally in the para-aortic, aortocaval, and right pelvic regions. Five days before admission, a computed tomographic (CT) scan of the thorax ( Figure 1) showed bulky right axillary lymphadenopathy. Several weeks before admission the hematocrit decreased to 18 percent. Two months before admission, the patient was seen at this hospital. Coronal T 1-Weighted MRI Image of the Right Shoulder Showing a Prominent Isointense Signal in the Proximal Humeral Metadiaphysis (Long Arrows) and in a Smaller Region More Distally (Short Arrow), Findings Consistent with Red-Marrow Reconversion. Axial CT Image of the Midabdomen at the Level of the Kidneys Showing a Soft-Tissue Mass Adjacent to the Left Renal Hilus (Arrow), a Finding Consistent with Lymphadenopathy. Axial CT Image of the Upper Thorax Showing Right Axillary Lymphadenopathy. The fever and sweats subsided, and the hematocrit rose to 25.5 percent. Prednisone (80 mg daily) was administered. A tuberculin skin test was negative, with positive controls. Microscopical examination of an aspirated bone marrow specimen showed erythroid hyperplasia. The urea nitrogen, creatinine, glucose, total protein, ferritin, and lactate dehydrogenase levels were normal the results of other tests are shown in Table 1, Table 2 and Table 3. ![]() Laboratory tests were performed at another hospital. The patient had been well until about five months earlier, when he began to have low-grade fever, night sweats, and nonpleuritic pain in the right deltoid region. The most trusted, influential source of new medical knowledge and clinical best practices in the world.Ī 32-year-old man was admitted to the hospital because of IgG antibody and Coombs'-positive hemolytic anemia resistant to corticosteroid treatment. Information and tools for librarians about site license offerings. ![]() Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.Ĭoncise summaries and expert physician commentary that busy clinicians need to enhance patient care. NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making.
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