@threatentensely asks: "fifteen sweep +ld male jade presents with cchief cc+nccern +f recctal pain. three wipes ag+, he devel+ped fever and s+re windcchute after w+rking w+th diseased grubs in the ccaverns. he was treated with + nights +f am++iccillin at an urgent ccull ccenter. +ver the last + nights, he has devel+ped persistent recctal pain, l+w grade fevers, and drencching day sweats with+ut rig+rs. he went bacck t+ the urgent ccull where they gave him t+piccal cc+rticc+ster+id. after a wipe +f that, his fever and pain persisted, and n+w he's here. vitals n+table for temp 36.8cc, bp 147/93, pusher rate 101 bpm, sp+2 95%. physiccal e+am unremarkable, n+ hem+rrh+ids, n+rmal abd+minal e+am. labs sh+wed white bl++d cc+unt +f 2.1, hem+gl+bin 8.7, platelets 12, inr 1.2, with n+rmal bmp/lfts. differential diagn+sis? - ++" >-8==— possible sepsis, hematologicc malignanccy (e.g. accute leukemia), thromboticc miccroangiopathy (tma) (e.g. thromboticc thromboccytopenicc purpura, ttp), disseminated intravasccular ccoagulation (dicc), hemophagoccyticc lymphohistioccytosis (hlh), heparin-inducced thromboccytopenia (hit) – if thromboccytopenia predominant >-8==— his ccurrent levels of ccytopenias do not require urgent transfusions of blood produccts. >-8==— although not ccurrently suffering from a fever it should be noted down as ccause for cconccern. >-8==— thinking of sepsis he is borderline tacchyccardicc with neutropenia and has a potential sourcce of infecction given loccalizing symptom of recctal irritation/pain (without hemorrhoids on e+am). further imaging would help cclarify potential sourcces of infecction and cchange management. thus, ccta/p with iv ccontrast is ordered. >-8==— other ccommon ccauses of panccytopenia incclude viral illnesses from being around sicck wrigglers. >-8==— possible diagnosis, post-viral panccytopenia, infiltrative bone marrow proccess, or accute leukemia. #medicchittr #asknurseiggy
why dxn’t they give yxu a white cxat already. x_X - xx
you may need to ser1ously cons1der blood transfus1on 1f theres an ant1gen1c match ava1lable sooner than later. w1th a susta1ned fever longer than 5 n1ghts, a CT scan should be run 1n add1t1on to another comprehens1ve metabol1c panel to check for early organ fa1lure, a potent1al sp1nal tap, and keep a look out for potent1al neuropathy bc of the fever. 95% O2 could be worth to do abdom1nal sonogram for presence of potent1al effus1on. rectal/fecal exam w1th bacter1al culture should have been done s1nce that was the ch1ef compla1nt but 1 d1gress. th1s may be closer to a v1ral and bacter1al co-1nfect1on w1th seps1s and/or v1rem1a rather than leukem1a due to the lack of bone pa1n and other cruc1al s1gns. D1C, TMA, HLH, H1T are less l1kely, but poss1ble 1f there 1s someth1ng that caused an 1n1t1ally 1ntense 1mmunolog1cal response. try look1ng 1nto v1ruses l1ke hepat1t1s, parvov1rus, or 1mmunodef1c1ency
>-8==— i dont know!!
