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A 72-year-old man presented with an abnormal blood count and was admitted.
His history included hypertension and hyperlipidaemia with an old myocardial infarction and mild stroke; liver cirrhosis due to non-alcoholic steatohepatitis (NASH) with hypersplenism and oesophageal varices but no ascites, oedema or bleeding; and benign prostatic hypertrophy. His medications (unchanged for years) included furosemide, spironolactone, bisoprolol, rosuvastatin, alfuzosin and omeprazole. Two weeks prior, he was discharged from our department after left leg cellulitis and Streptococcus pyogenes bacteraemia responsive to parenteral clindamycin and ceftriaxone (later changed to penicillin G) continued for 10 days. On discharge, haemoglobin was 10.2 g/dL (mean corpuscular volume 96), …
Contributors Both authors had a role in writing the manuscript composed primarily by AS.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
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