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Postgraduate Medical Journal 2002;78:569; doi:10.1136/pmj.78.923.569
Copyright © 2002 The Fellowship of Postgraduate Medicine.
Postgraduate Medical Journal 2002;78:569
© 2002 The Fellowship of Postgraduate Medicine

Unusual cause of fever, jaundice, and hepatomegaly in a middle aged man

The first 150 words of the full text of this article appear below.

Q1: In this patient’s clinical context, how do you interpret the laboratory tests on admission (table 1; see p 566) and those done between days 2–4 (table 2; see p 566)

This patient had a subacute febrile illness with constitutional symptoms and progressive jaundice. Initial laboratory tests showed severe anaemia with an increased reticulocyte count (corrected for the degree of anaemia) and red cell distribution width, predominantly direct hyperbilirubinaemia, modest elevations in transaminases and alkaline phosphatase, hypoalbuminaemia, and mild renal impairment. The abdominal computed tomogram finding of asplenia was later confirmed to be due to splenectomy done during trauma surgery many years earlier. This imaging study also excluded biliary obstruction, pyaemic liver abscess, and tumour as causes of his jaundice. Serial blood tests done between days 2–4 revealed decreasing haemoglobin levels, increasing macrocytosis and reticulocytosis, high lactate dehydrogenase, and low haptoglobin levels. This was consistent with haemolysis. The negative blood cultures and absence of radiographic evidence of biliary obstruction made cholangitis less likely as a cause for his fever. Infectious conditions that can produce haemolytic anaemia are listed in box 1Go. . . [Full text of this article]


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Unusual cause of fever, jaundice, and hepatomegaly in a middle aged man
S Kumar, S Uthamalingam, A R Vasudevan, A Lim, A Feliz, J M Brensilver, and R Yarrish
Postgrad. Med. J. 2002 78: 566. [Extract] [Full Text] [PDF]

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