Hematology Case 6

THIS PATIENT HAS BEEN COMPLAINING OF FEVER , DRY COUGH AND SOB FOR 30 DAYS SHE WAS ADMITTED TO A HOSPITAL FOR 24 DAYS AS CASE OF PNEUMONIA TO R/O MERS-OCV , HER MERS-COV , SCREENING WAS NEGATIVE , AS WELL AS TB R/O SHE WAS TREATED WITH TAZOCIN , LINEZOLID AND GENTAMYCIN IN THAT HOSPITAL , BUT THERE IS NO IMPROVEMENT IN HER CONDITION .

SHE WAS REFEREED TO OUR HOSPITAL TO HEMATOLOGY BECAUSE OF LOW HB , AND PLTS WHEN ARRIVED SHE WAS BEING ENDORSED TO FEMALE CUBICLE WITH OUT ISOLATION , THEN SHIFTED TO ISOLATION WHEN CXR DONE WHICH SHOWED BILATERAL INFILTERATES AND A BIG CONSOLIDATION INVOLVING RT UPPER PART OF THE LUNG

PATIENT WAS SICK , ILL , DEHYDRATED DYSPNOEIC AND TACKYCARDIC , NOT FEBRILE AT THAT TIME , BUT PALE AND NOT JAUNDICED HR =112 , BP 115/60 , SPO2 85 % RA , 100 % ON O2 , RR =20 CHEST HAS REVEALED RT UPPER COARSE REPS ON RT SIDE AND DECRESED BREATH SOUNDS ON BILTERAL LOWER ZONES OF THE CHEST CVS , S1 , S2 AUDIBLE , TACHYCARDIA ABDOMEN GENERALIZED MILD TENDERNESS , NO ORGANOMEGALY NO LOWERR LIMBS EDEMA CXR =BILTERAL HAZZINESS ESP ON RT UPPER PART , INFILTERATES ECHG SINUS TACHYCARDIA

SEVERE PNEUMONIA TO R/O MERS-COV

Leucocytes are normal in number , presence of promonocyte, Blasts 30% large cell with high nuclear/cytoplasmic ratio , presence of nucleoli , vaculation , bluish cytoblasm ( mostly monocytic origin ).

Severe Macrocytic normochromic anemia

Marked thrombocytopenia

Provisional diaqgnosis : Acute myloid Leukemia is suspected for immunophenotyping and cytogenetic studies