Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this patient is a 26 year old female who presents to the clinic for evaluation of fatigue. She is in no acute distress, but reports: “I just feel lousy and tired all the time.”
HPI: The patient is a previously healthy 26 year old female presenting for evaluation of 1.5-month fatigue. She reports that she does not “have the energy that I usually do.” She denies any precipitating factors or experiencing this before. Patient reports that despite getting enough sleep each night, she constantly feels exhausted and no longer has the energy to do the things she used to do. During this time she also states that she has had occasional low-grade fevers and night sweats. She states that she has “just felt bad” with recurrent achiness and malaise. She reports that these symptoms typically occur for a few days, improve for 1-2 days, and then begin again. Nothing seems to make them any better or worse.
SH: Patient works for a local consulting firm. She denies any current or prior use of tobacco. States that she has a glass of wine once a week, but denies any more use than that. Patient reports that she regularly has 3 cups of coffee each day and that she jogs 5 miles 4x a week. She lives alone and is unmarried.
FMH: Father- Alive at 55 and has HTN, Mother- Deceased at age 44 and had Non-Hodgkin’s lymphoma
General- Unintended 18lb weight loss in the past month
HEENT: No visual or hearing changes. No dysphagia. She notes that she had noticed some swollen lymph nodes a few weeks ago.
Abdomen- Patient states that she hasn’t felt like eating for the past couple of weeks. No recent diarrhea, constipation, nausea, or vomiting. No recent abdominal pain.
Musculoskeletal: Reports frequent arthralgias in the past month.
VS- Height 5’8’’, Weight 130lbs, BMI 19.8 HR 60, BP 124/88, RR 12, Temperature 99.7
General Appearance- Patient is cooperative and in no acute distress.
Neck- Left anterior cervical lymph nodes are hard, matted, and non-tender. No occiput, auricular, submandibular, submental, or supraclavicular lymphadenopathy present.
Hemoglobin 13.0 mg/dl, Hct- 39%, RBCs- 4.9 million/mcl, WBCs- 18 million/mcl
Neutrophils- 62%, Monocytes- 3%, Lymphocytes -33%, Basophils- 0%, Eosinophils- 0%
- Lymph Node Biopsy- Positive for lymphoblastic lymphoma