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18 year old female with no significant past medical history, who presented to the hospital with 8 week history of fever, weight loss, and joint pain , her physical examination revealed temperature of 100.8, pale conjunctiva, clear lungs, systolic ejection murmur at the apex, benign abdomen and extremities with no lesions, there was no lymphadenopathy felt. Laboratory finding reveled Hg of 9.4 and Creatinine of 1.3 , normal electrolytes, and slight elevation in liver function tests. Her white blood count was 16.6, all cultures were negative including blood and urine. Her chest X-ray was negative. Patient was started on ceftriaxone empirically and an echocardiogram reveals mass lesion in the left atrium.:
Patient was started on Vancomycin and Gentamicin for the possibility of endocarditis, because of elevated liver function tests, she had a liver biopsy which confirmed the diagnosis of large T cell immunoblastic lymphoma
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