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Case study interpretation—Houston: Case 1

CASE HISTORY This patient is a 54-year-old man who was referred to the hematology/oncology service with a recent onset of fevers, cervical lymphadenopathy, absolute lymphocytosis, and mild splenomegaly. His past medical history was significant for seizures, which had been well controlled on Dilantin for the past 8 years. Laboratory data were significant for a mildly increased WBC of 11.9 K/cumm (normal: 4.5–11) showing absolute lymphocytosis (Fig. 1), a thrombocytopenia of 104 K/cumm (normal: 140–400), increased liver function tests of alanine transaminase of 64 IntUnits/L (normal: 17–63) and aspartate transaminase of 65 (normal: 15–41), and an erythrocyte sedimentation rate (ESR) of 14 mm/h (normal: 0–10). The phenytoin level was 5.8 mcg/mL (therapeutic range: 10–20). Peripheral blood was sent for flow cytometric analysis to assess the absolute lymphocytosis.