Differential diagnosis of pancytopenia – a case report

Czech version

Authors: E. Kadlčková ¹; P. Rohoň ²; M. Navrátil ³; L. Křen ⁴; I. Zimová ⁵; J. Palíšek ⁶; J. Staníček ⁷; I. Ryšavý ⁸
Authors‘ workplace: Hematologicko-transfuzní oddělení Krajské nemocnice T. Bati Zlín ¹; Hemato-onkologická klinika Fakultní nemocnice a Lékařské fakulty Univerzity Palackého Olomouc ²; Interní hematoonkologická klinika (IHOK) Fakultní nemocnice Brno-Bohunice ³; Ústav patologie Fakultní nemocnice Brno-Bohunice ⁴; Klinika anesteziologie, resuscitace a intenzivní medicíny (KARIM) Fakultní nemocnice Brno-Bohunice ⁵; Radiodiagnostické oddělení Krajské nemocnice T. Bati Zlín ⁶; Oddělení nukleární medicíny Masarykova onkologického ústavu Brno, Žlutý kopec ⁷; Interní klinika Krajské nemocnice T. Bati Zlín ⁸
Published in: Transfuze Hematol. dnes,20, 2014, No. 3, p. 59-66.
Category: Comprehensive Reports, Original Papers, Case Reports

Overview

The aim of this paper is to report the differential diagnosis undertaken in a 47-year-old patient who was admitted for severe pancytopenia at the Department of Internal Medicine, Tomas Bata Regional Hospital in Zlín in August 2012. As the initial examinations regarding inflammation, tumours, infections and systemic diseases were negative, myelodysplastic syndrome was suspected. Trephine biopsy was performed, but myelodysplastic syndrome was not confirmed. The patient quickly became dependent on transfusions and suffered from recurrent infections. The differential diagnostic process was further complicated by the patient’s repeated refusal to be hospitalized at the department of Internal Medicine. Repeated CT scans showed increasing splenomegaly and eventually multiple osteoplastic and mixed deposits in the pelvic bone appeared, pointing to a probable malignancy. The patient was referred for further investigation to the Department of Internal Medicine, Haematology and Oncology Clinic, University Hospital Brno-Bohunice. The indicated whole-body PET/CT found extensive deposits of viable tumour tissue in the chest wall. Histological samples were taken and corticosteroid treatment was started. However, this resulted in tumour lysis syndrome followed by kidney failure. The patient developed multiple organ failure with disseminated intravascular coagulopathy and died on the day that the histological diagnosis of undifferentiated sarcoma was made.

Key words:
myelodysplastic syndrome, (pan)cytopenia, sarcoma

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