Case 700 -- A 55 year-old male with weakness and altered mental status

Contributed by David Cohen, PSF, MS4; Milon Amin, MD; and Jay S. Raval, MD


This 55 year-old gentleman is status-post laryngectomy for squamous cell carcinoma of the larynx diagnosed in 2010, complicated by a tracheostomy occlusion, leading to cardiopulmonary arrest and subsequent hypoxic brain injury. He was admitted with new-onset altered mental status, after weakness for approximately 6 months. On admission he was found to be severely malnourished.

During his hospital course, thrombocytopenia and acute kidney injury were noted. A renal biopsy showed thrombotic microangiopathy. His blood cultures were positive for Salmonella. On day 4 of admission, he developed hemoptysis and a thick, bloody drainage from his tracheostomy. He was subsequently transferred to the MICU. His platelet level was 89,000/cu mm (reference range: 156,000 - 369,000 / cu mm). His B-type natriuretic peptide level was 2860 pg/mL. His peripheral blood smear is shown below (Image 1).

At this point, what hematologic condition must be considered in the list of underlying conditions for this patient?

  1. IgA deficiency
  2. Immune thrombocytopenic purpura (ITP)
  3. Thrombotic thrombocytopenic purpura (TTP)
  4. Myelodysplastic syndrome
  5. Multiple myeloma

Case Continues

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