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 Best of Five 2.2

 

   

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BOF: 2.2

A 59-year-old male presents with a history of cough, fever and pleuritic chest pain. He had been feeling unwell for several months, complaining of feeling tired and breathless.  He had consulted his GP about this and was noted to have splenomegaly but this had been attributed to tropical splenomegaly syndrome as he had spent several years in India and had had malaria several times. No investigations had been performed as his symptoms of feeling tired and breathless had been attributed to stress at work. He was not on any drugs; he smoked heavily; 20 cigarettes a day for the last 30 years.

On examination he looked unwell, he was febrile, there was no clubbing, there was consolidation in the base of his left lung and he had hepatosplenomegaly.

Investigations:

Chest x-ray confirmed consolidation in the base of his left lung.

Hb 7.6 g/dL

WBC 56.9 x 109/l

Neutrophils 41%

Metamyleocytes 8%

Myleocytes 21%

Promyelocytes 18%

Blast cells 9%

Nucleated red cells 3%

Platelets 49x109/l

The features are likely to be the result of a complication of:

a)      Tropical splenomegaly syndrome

b)      Bacterial pneumonia

c)      Bronchial carcinoma

d)      Acute myeloid leukaemia

e)      Chronic myeloid leukaemia

 

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