Prolonged Fever, Hepatosplenomegaly, and Pancytopenia in a 46-Year-Old Woman 英文参考文献.docVIP

LearningForum ProlongedFever,Hepatosplenomegaly,and Pancytopeniaina46-Year-OldWoman LiranLevy1*,AbedelmajeedNasereddin2,MosheRav-Acha1,MeiravKedmi3,DeborahRund3,MosheE. Gatt3 1Department ofInternal Medicine,Hadassah-HebrewUniversityMedicalCenter,Jerusalem,Israel, 2Department ofParasitology,Hadassah-HebrewUniversityMedical Center,Jerusalem,Israel,3DepartmentofHematology,Hadassah-HebrewUniversityMedicalCenter,Jerusalem,Israel DescriptionofCase patient’s history, physical examination, and routine screening blood tests and cultures. In this case the history gives no apparentclue;thereforetheorganomegaly shouldbethebasisfortheassessment.The massive splenomegaly narrows down the cannot be ruled out and should be investigated as an underlying disorder preceding a more common cause for prolongedfever. A 46-year-old woman was hospitalized due to fever of up to 39uC of one week’s duration. The patient complained of Multipleblood,urine,andstoolcultures were negative. The patient’s laboratory weakness, night sweats, and weight loss for two weeks prior to admission. The patient had no past medical history, and did not take any medications, supple- ments, or illicit drugs. She was born and livedallherlifeinaruralvillage.Shewas indirectly exposed to farm animals and pets, yet had no close contact with these, and her family was not engaged in agriculturalwork.Shedeniedhavingbeen bitten by ticks or fleas. There was no history of recent foreign travel or eating raw meat or unpasteurized milk. She reported no rashes, arthralgia, dryness of eyes, mouth ulcers, or mucocutaneous bleeding. differential diagnosis, as only a few results revealed pancytopenia with 2,800 leukocytes/mm3 (2,200 neutrophils, 400 conditions generally cause this degree of splenicenlargement(Box1).Theseinclude infectious causes, such as bacterial (ty- phoid fever, Mycobacterium tuberculosis , or AIDSwith M. avium complex) and fungal agents (histoplasmosis), but more com- monlysplenomegalyresultsfro