Contributed by Valerie A. Lyons, MD
Published on line in April 1999
The patient is a 62-year-old male who was in excellent health with no significant past medical history, when he presented with a 4 week history of fatigue and malaise. Upon admission he was found to be febrile and pancytopenic without lymphadenopathy or splenomegaly. Blood cultures were negative. Hepatitis A, B, C, EBV, CMV, ANA, RA and PPD were negative. Echocardiogram and CT of the head were normal. CT scan of the liver revealed multiple focal, hypodense lesions in the right lobe, without biliary dilation. A bone marrow biopsy, and a splenic fine needle aspiration were preformed which revealed a malignant B-cell lymphoma. In addition there appeared to be a separate, smaller population of lymphoid cells with a CD2 positive, CD3 negative NK-type cell phenotype. The patient rapidly deteriorated with multiorgan failure and bouts of hypotension which led to his demise.