Case Review 2

A 69 year-old male farmer, non-smoker, was admited to our department due to dyspnea on exertion, night sweats during the last two months and severe thrombocytopenia revealed during a routine screening by his general practitioner. The patient had a medical history of congestive heart failure, and osteoarthritis.

Physical examination

• temperature 36.8°C, 
• pulse rate 80 beats/min, 
• blood pressure 150/90 mmHg, 
• respiratory rate 20 breaths/min and oxygen saturation 94% on room air.
• Auscultation disclosed decreased breath sounds at the right lower base, with dullness on percussion. 
• In addition the patient had ecchymoses in his lower limps and trunk without petechiae. Laboratory work-up showed: hemoglobin 15.6 g/dL, white blood cell count 10,900 cells/µL (71% neutrophils and 18% lymphocytes), and platelet count 20,000 cells/µL. Prothrombin time and partial thromboplastine time where within normal limits, as well as the rest of the laboratory tests
• Chest XRay:

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