Laboratory medicine · 2014
Accidental diagnosis: Aeromonas infection leading to discovery of acute myeloid leukemia with meylodysplastic syndrome.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Rausch Spencer
Аннотация
PATIENT: 47-year-old African American man.
CHIEF COMPLAINT: Initially, serious finger abscess. The patient reported severe pain that was localized to that finger only.
HISTORY OF PRESENT ILLNESS: His finger had become sore and then progressively more painful and swollen.
PAST MEDICAL HISTORY: A few weeks earlier, the patient had had a similar abscess on his leg; he could not recall any specific injuries other than this. He had a past history of epilepsy that is totally unrelated to this case; he had not had any episodes in more than 10 years. Otherwise, the medical history of the patient was relatively healthy: he is a nonsmoker with no history of diabetes or steroid use.
SOCIAL HISTORY: Patient washed cars for a living.
FAMILY HISTORY: Noncontributory.
PHYSICAL EXAMINATION: Initially, the patient was sent home with a course of antibiotics (cephalexin and trimethoprim/sulfamethoxazole) and was asked to return to the hospital for follow up within two days. By the time of the follow-up visit, the antibiotic treatment had been unsuccessful, and the patient experienced more pain in the finger; the flesh of the finger was becoming black and necrotic. The patient tested positive for all myeloid markers: myeloperoxidase (MPO), CD34, CD33, CD13, CD45, human leukocyte antigen–DR subregion (HLA-DR), CD15, and CD11c. Trilinear dysplasia was indicated by the results of bone-marrow studies and peripheral blood smear testing.
CHIEF COMPLAINT: Initially, serious finger abscess. The patient reported severe pain that was localized to that finger only.
HISTORY OF PRESENT ILLNESS: His finger had become sore and then progressively more painful and swollen.
PAST MEDICAL HISTORY: A few weeks earlier, the patient had had a similar abscess on his leg; he could not recall any specific injuries other than this. He had a past history of epilepsy that is totally unrelated to this case; he had not had any episodes in more than 10 years. Otherwise, the medical history of the patient was relatively healthy: he is a nonsmoker with no history of diabetes or steroid use.
SOCIAL HISTORY: Patient washed cars for a living.
FAMILY HISTORY: Noncontributory.
PHYSICAL EXAMINATION: Initially, the patient was sent home with a course of antibiotics (cephalexin and trimethoprim/sulfamethoxazole) and was asked to return to the hospital for follow up within two days. By the time of the follow-up visit, the antibiotic treatment had been unsuccessful, and the patient experienced more pain in the finger; the flesh of the finger was becoming black and necrotic. The patient tested positive for all myeloid markers: myeloperoxidase (MPO), CD34, CD33, CD13, CD45, human leukocyte antigen–DR subregion (HLA-DR), CD15, and CD11c. Trilinear dysplasia was indicated by the results of bone-marrow studies and peripheral blood smear testing.