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Soup
HPI: 77 yo male with past medical history of prostate cancer and asbestos exposure who presented to Valley City with a 3-day hx of fever to 39°, abdominal pain and generalized malaise.
Patient past history is remarkable for headaches for 6 weeks. Prednisone 40 mg/day x 6 weeks with tapering doses was started for the possibility of temporal arteritis, temporal artery bx obtained 1 week prior to admission showed no evidence of temporal arteritis. PE: Temp: 100º C, RR18 BP 120/70, HR 80. PE unremarkable. No skin lesions, liver not palpable, no ascites, no asterexis. CT abd / pelvis revealed 5 x 7 cm mass L kidney no renal vein involvement, Liver homogenous low attenuation , no adenopathy, spleen / pancreas normal .
Laboratory Findings
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Day 1
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Day 2
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Day 4
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T bili
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2.0
|
2.9
|
3.7
|
|
AST
|
644
|
5181
|
8600
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|
ALT
|
639
|
5056
|
7200
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|
Alk P
|
81
|
95
|
120
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PT
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14.2
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25
|
30
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aPTT
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43.5
|
136
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> 150
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WBC
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6.1
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4.4
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|
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Hb
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16.2
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11.6
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5
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Plt
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29
|
20
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|
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LDH
|
936
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|
9700
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Day 2 : Hep A, B, C, EBV, CMV pending.
Day 3: Pt with encephalopathy, hypotension and transferred to ICU with DIC.; Hepatitis serologies: A, B, C –ve.; Varicella IgM –ve, IgG +; EBV / CMV –ve
Day 4: Progressive decline, withdrawal of life support., and death
Autopsy was done: Make your choice from the selection box to view the slide on the right
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