Teaching Cases from the Royal Marsden Hospital Case 4: fever, hepatic dysfunction and cytopenia

CASE A 67 year old English male presented with a six month history of shortness of breath, malaise, lethargy, fever, and night sweats. He had not suffered pruritus or alcohol-induced pain. There was no history of recent travel. He had no hepatomegaly, lymphadenopathy, splenomegaly or abnormal findings in the chest. Results of laboratory tests were: Hb 10 g/dl, MCV 89 fl, WBC 3.8 × 109/1, neutrophil count 2.5 × 109/1, lymphocyte count 1.1 × 109/1, monocyte count 0.04 × 109/1, platelet count 269 × 109/1, ESR 116 mm/hr, aspartate transferase 44IU/1 (NR