The Clinical Problem Solvers Episode 81: Human Dx unknown with Dr. André Mansoor & OHSU residents – dyspnea and weight loss
Dr. Ruchit Rana presents a Human Dx unknown to Dr. André Mansoor and OHSU residents – Drs. Logan Jones and Patricia Liu.
Dr. Logan Jones
“Logan” Jones is a PGY-3 at OHSU in Portland, and will be joining the faculty as an assistant professor in the Division of Hospital Medicine with an academic focus on student assessment, curricular innovation, learner scholarship, clinical reasoning, and EMR proficiency. He is active in organized medicine with the American Medical Association and the American College of Physicians. Outside of medicine, he enjoys cooking with his sig fig Samantha, spending time on his yoga mat, and hiking throughout the Pacific Northwest.
Dr. Patricia Liu
Pat is currently one of the IM chief residents at Oregon Health & Science University. She will be a hospitalist next year and is interested in medical education, empowering women in medicine and improving care for inpatients with substance use disorders. In her free time, you can find her running, snowboarding and teaching tricks to her cat, Pekoe.
Dr. Ruchit Rana
Ruchit Rana is currently a second-year internal medicine resident at Baylor College of Medicine. He completed medical school at Baylor College of Medicine. He has a passion for practicing and improving medical education at all levels. In his free time, he enjoys cooking and baking dishes across all ethnicities and maintaining his multiple freshwater aquariums at home.
Dr. André Mansoor
André Mansoor is an Assistant Professor of Medicine at Oregon Health and Science University in Portland, Oregon. His favorite book is the Count of Monte Cristo and his favorite band is Stone Temple Pilots. He is the author of an internal medicine textbook called Frameworks for Internal Medicine. https://www.amazon.com/Frameworks-Internal-Medicine-Andre-Mansoor/dp/1496359305.
Case Summary
A 70-year-old man presented with six months of dyspnea on exertion, night sweats, and weight loss. He was found to be febrile and in distributive shock, with laboratory analysis demonstrating cytopenias, coagulopathy, and lactic acidosis. Computed tomography of the abdomen and pelvis was notable for hepatosplenomegaly, and a bone marrow biopsy revealed a monoclonal B-cell population with hemophagocytosis. The patient was diagnosed with diffuse large B-cell lymphoma complicated by hemophagocytic lymphohistiocytosis (HLH).
Teaching Points:
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening, immune-mediated disease caused by impaired NK and cytotoxic T-cell function. While genetic defects play a prominent role in triggering HLH in children, most cases of HLH in adults are secondary to another disorder, such as infections (e.g., EBV, histoplasmosis), hematologic malignancies (e.g., NK, T, or B-cell lymphomas), or autoimmune disease (e.g., systemic lupus erythematosis).