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Clinical Case

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  1. 1. 39 year old male patient presented with complains of:  Fever X 3 days  Arthralgia ,Backache
  2. 2. G/C:ILL Looking ANEMIC:+,LN:Multiple Lymph Node present on both side of Diaphragm Vitals: Temperature:39.2C Chest:B/L Clear Pulse:114/min CVS:S1,S2,M+(Grade 3 SM+) B/P:110/60mmHg P/A:Soft tender, massive Splenomegaly R/R:20/min Hepatomegaly+
  3. 3.  MEDICAL h/o:Negative h/o DM,HTN,PTB,HEPATITIS  SURICAL h/o:Non Significant  Allergic h/o:Non Significant  Personal h/o:Alcoholic+,non smoker
  5. 5.  WBC:6.56 X 10*9/L Neutrophil Count:1.13 x 10*9/L,17.2% Lymphocyte Count:14.61 x 10*9/L,70.2%  RBC:2.12 X 10*12/L,Hb:63g/L,MCV:88.2fl,HCT:18.7%  Platelets:30 x 10*9/L
  6. 6. ESR:97mm/hr CRP:93mg/L LDH:>1200U/L
  7. 7. ? Bone Marrow Malignancy Multiple Myeloma Lymphoma Infective Endocarditis Tropical Infection
  8. 8. ALL:L2 Febrile Neutropenia
  10. 10. TYPES ANC (Absolute Neutophil Count) MILD NEUTROPENIA (1.5 – 1 X 10*9/L) MODERATE NEUTROPENIA (1.0 – 0.5 X 10*9/L) SEVERE NEUTROPENIA (<0.5 X 10*9/L)
  11. 11. Decreased Production in Bone Marrow:  aplastic anemia  arsenic poisoning  cancer, particularly blood cancers  certain medications  hereditary disorders (e.g. congenital neutropenia, cyclic neutropenia)  radiation  Vitamin B12, folate or copper deficiency
  12. 12.  Increased Destruction:  autoimmune neutropenia  chemotherapy treatments, such as for cancer and autoimmune diseases  Medications :  Flecainide (a class 1C cardiac antiarrhythmic drug)  Phenytoin  Indomethacin  Propylthiouracil  Carbimazole  Chlorpromazine  Trimethoprim/ sulfamethoxazole (cotrimoxazole)  Clozapine  Ticlodipine
  13. 13. AdultT cell leukemia-lymphoma: Abbreviated ATL. A malignancy of matureT lymphocytes (T cells) with its onset in adulthood caused by infection with the humanT- lymphotropic virus type 1 (HTLV-1) and characterized by circulating malignantT-lymphocytes, skin lesions, lymphadenopathy (enlarged lymph nodes), hepatosplenomegaly (enlarged liver and spleen), hypercalcemia (high blood calcium), lytic ("punched out") bone lesions, and a tendency to infection.
  14. 14. Recommended treatment strategy for patients with acute, lymphoma, or chronic/smoldering ATL. MRD indicates minimal residual disease. Bazarbachi A et al. Blood 2011;118:1736-1745 ©2011 by American Society of Hematology
  15. 15. How to select best antibiotics for a case of Fever with Neutropenia? Is addition of G-CSF worthy in treatment of Neutropenia? Fever,Murmur,Splenomegaly is highly suggestive of IE.Is it necessary to do Echocardiogram & Bloood C/s? Is this aggressive form of Acute Leukemia?
  16. 16. Charts from _0.jpg Influenced from,
  17. 17. THANK YOU