Issues in Infectious DiseaseFever of unknown origin (FUO) due to large B-cell lymphoma: The diagnostic significance of highly elevated alkaline phosphatase and serum ferritin levels
Section snippets
Case
A 63-year-old woman, born in El Salvador, was admitted after 6 weeks of high fevers. Vital signs during admission included a temperature of 102.3°F and a pulse of 98/minute (relative bradycardia). Her physical examination was otherwise unremarkable. During hospitalization for her FUO workup, she continued to manifest fevers >102°F, chills, and night sweats.
Laboratory tests included a WBC count of 4.2 K/mm3 (lymphocytes, 14%; monocytes, 17%). Her hemoglobin level was 10.9 g/dL, her hematocrit
Discussion
This case of FUO was interesting in several respects. Firstly, although typhoid fever, visceral leishmaniasis, and miliary TB were initial diagnostic considerations, nonspecific laboratory findings suggested malignancy.3, 4, 5, 6 The problem involved localizing the malignancy to an organ to limit the differential diagnostic possibilities and to provide a tissue diagnosis.12, 20 Her imaging studies revealed conflicting results, ie, her gallium scan indicated increased uptake in the uterus, but
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