Case 982-- An Elderly Man with an Unusual Peripheral Blood Smear

Contributed by John M. Skaugen, MD, Nidhi Aggarwal, MD, and Grant Bullock, MD, PhD


The patient was an elderly man with history of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), recently started on ibrutinib, who presented with high fever, chills/rigors, night sweats and altered mental status. He was also noted to be hypotensive, which responded to IV NS. His spleen was enlarged, measuring up to 14.6 cm on ultrasound. He had no known significant recent exposures or travel. This occurred in the winter.

Laboratory data (at/near admission):

A peripheral blood smear demonstrated the following:

A bone marrow biopsy demonstrated the following:


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