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Dr. Robert B. Den (Medicine): A 33-year-old man was admitted to this hospital because of fever, abdominal pain, and pancytopenia.
The patient had received a cadaveric renal allograft 15 years earlier because of glomerulonephritis, after which he had been treated with an immunosuppressive regimen of prednisone, azathioprine, and cyclosporine. At a routine follow-up visit approximately 4 months before admission, results of laboratory tests revealed a white-cell count of 1700 per cubic millimeter (18% neutrophils) and a platelet count of 107,000 per cubic millimeter. Azathioprine was discontinued, and the patient was referred to a hematologist. Blood cultures were sterile, and testing
Differential Diagnosis
Benign Hematologic Conditions
Cancers
Post-Transplant Lymphoproliferative Disorders
Hepatosplenic T-Cell Lymphoma
Infectious-Disease Considerations
Differential Diagnosis of Abdominal Findings
Clinical Diagnosis
Dr. Jeremy S. Abramson's Diagnosis
Pathological Discussion
Discussion of Management
Anatomical Diagnosis
Source Information
From the Cancer Center (J.S.A.), the Infectious Disease Unit (C.N.K.), Transplant Surgery (N.E.), and the Departments of Radiology (D.V.S.) and Pathology (R.P.H.), Massachusetts General Hospital; and the Departments of Medicine (J.S.A., C.N.K.), Surgery (N.E.), Radiology (D.V.S.), and Pathology (R.P.H.), Harvard Medical School.
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