39 year old male patient presented with complains of:

Fever X 3 days Arthralgia ,Backache

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 SplenomegalyR/R:20/min Hepatomegaly+

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

INVESTIGATIONS

WBC:6.56 X 10*9/LNeutrophil 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

ESR:97mm/hrCRP:93mg/LLDH:>1200U/L

? Bone Marrow MalignancyMultiple MyelomaLymphoma Infective EndocarditisTropical Infection

ALL:L2

Febrile Neutropenia

LITERATURE

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)

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

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

Adult T cell leukemia-lymphoma: Abbreviated ATL. A malignancy of mature T lymphocytes (T cells) with its onset in adulthood caused by infection with the human T-lymphotropic virus type 1 (HTLV-1) and characterized by circulating malignant T-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.

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

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?

Charts from www.fbnotebook.com

https://pedclerk.bsd.uchicago.edu/sites/pedclerk.uchicago.edu/files/uploads/management_0.jpg

Influenced from ncbi.nlm.nih.gov/,www.bloodjournal.org

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