Man with Colitis and Pancytopenia

Alison Woodworth

A 32-year-old Caucasian male presented to the emergency department with complaints of bloody diarrhea 20 times per day and dehydration. A CBC was notable for anemia with normal white blood cell and platelet counts. Past medical history was significant for Crohn's disease diagnosed at age 20 involving the small and large intestines. He underwent ileocecal resection, and had been asymptomatic and required no therapy for the past 5 years. During his 2-day hospital course, anemia and dehydration were corrected, the diarrhea resolved, and immunosuppression with prednisone and azathioprine was started to treat a flare of inflammatory bowel disease.

Three weeks later, he returned to the gastroenterology clinic for a follow-up appointment during which he complained of fevers, chills, and rectal pain for the past 3 days. On physical examination he was diaphoretic, febrile (39.8°C), and tachycardic, and experienced pain with movement. No lymphadenopathy was appreciated, and lung and heart exams were normal. His abdomen was mildly tender with hypoactive bowel sounds. No ascites or peripheral edema was noted.

Laboratory data included the following:

Reference

Value,

Interval,

Reference

Conventional

Conventional

Value,

Interval,

Analyte

Units

Units

SI Units

SI Units

WBC

0.6 x 103/mL

3.8-9.8

0.6 x 109/L

3.8-9.8

Neutrophil count

0.0 x io3/mL

1.7-6.7

0.0 x 109/L

1.7-6.7

Lymphocyte count

0.6 x 103/mL

0.9-3.2

0.6 x 109/L

0.9-3.2

Monocyte count

0.0 x i03/mL

0.2-0.9

0.0 x 109/L

0.2-0.9

Hemoglobin

8.2 g/dL

13.8-17.2

82 g/L

138-172

Hematocrit

23%

41-50

0.23 volume

0.41-0.50

Platelets

42 x 103/mL

140-440

42 x 109/L

140-440

Sodium

145 mmol/L

135-145

Same

Potassium

3.5 mmol/L

3.3-4.9

Same

Value, Conventional Units

Reference Interval, Conventional

Value, SI Units

Same Same

Reference Interval, SI Units

Analyte

Chloride

CO2, total

Glucose

Urea nitrogen

Creatinine

Protein, total

Albumin

Bilirubin

106 mmol/L 29 mmol/L 98 mg/dL 19 mg/dL 1.3 mg/dL 7.0 g/dL 3.6 g/dL 37 IU/L 50 IU/L 0.4 mg/dL

Units

62-133

68-85

Chest x-ray showed no active disease. Blood cultures were positive for Esherichia coli and Streptococci viridans. Urine cultures were negative. A bone marrow biopsy and aspirate were markedly hypocellular (<10% cellularity, normal for 30-year-old adult ^70%) without features of myelodysplasia or a myeloid or lymphoid malignancy.

Was this article helpful?

0 0
How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

Get My Free Ebook


Post a comment