Clinical Case

2. 39 year old male patient presented with
complains of:
 Fever X 3 days
 Arthralgia ,Backache

3. 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+

5.  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

6. INVESTIGATIONS

7.  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

12. ESR:97mm/hr
CRP:93mg/L
LDH:>1200U/L

15. ? Bone Marrow Malignancy
Multiple Myeloma
Lymphoma
Infective Endocarditis
Tropical Infection

16. ALL:L2
Febrile Neutropenia

17. LITERATURE

18. 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)

19. 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

20.  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

28. 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.

30. 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

31. 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?

32. Charts from www.fbnotebook.com
https://pedclerk.bsd.uchicago.edu/sites/pedcl
erk.uchicago.edu/files/uploads/management
_0.jpg
Influenced from
ncbi.nlm.nih.gov/,www.bloodjournal.org

34. THANK YOU