CLINOCOPATHOLOGIC

CASE CONFERENCE
GROUP 10
Andres| Aquilizan|Begonia| Castro|
Jha|Modi|
Pascua|Pasion|Parong|S. Rivera
This is patient
RB
19 years old
Male
Unemployed
Roman
Catholic
Single
January 19,
1996
 CHIEF
COMPLAINT

19 years old
Male
Unemployed Generalized
Roman
Catholic body weakness
Single
January 19, for 10 days
1996
 2 years PTA
LLQ palpable, superficial
mass
 2 years PTA
LLQ palpable,
superficial mass
Consult at a
Government hospital
and Incision and
drainage was done
Meds: Cotrimoxazole,
Amoxicillin, and
Mefenamic acid
 2 years PTA
LLQ palpable,
superficial mass
Consult at a
Government hospital Diagnosis:
and Incision and
drainage was done Extrapulmonary
Meds: Cotrimoxazole,
Amoxicillin, and
Tuberculosis
Mefenamic acid (no meds given)
(+) left axillary and
lateral neck mass 
resolved
 9 months PTA
Cough, productive of
whitish phlegm
No consult done
 6 months PTA
Bipedal edema
Palpable Mass at Right
Diagnosis: subcostal area
Intermittent, undocumented
Kidney Disease fever
(+) discoloration of eyes
(Discharge with deep yellow urine
with ↓ in
icteresia,
edema
resolved)
 10 days PTA
Generalized body weakness
Recurrence of bipedal edema
Yellowish discoloration of eyes
and skin
Intermittent Fever Diagnosis:
RUQ pain
Sough consult and admitted Anemia of
Chronic illness
(t/c PTB; Liver
pathology)
 SALIENT
FEATURES
 Histor
y
(+) left axillary and Generalized body
lateral neck mass  weakness
Recurrence of bipedal
resolved edema
Diagnosis: Extrapulmonary
TB (no meds given) Yellowish discoloration
of eyes and skin
Cough, productive of
whitish phlegm Intermittent Fever
Bipedal edema RUQ pain
Palpable Mass at Right Has weight loss
subcostal area
Intermittent,
undocumented fever
(+) discoloration of eyes
with deep yellow urine
Physical exam
Cachectic
Decreased Blood
pressure
Increased
Respiratory rate
Increase Cardiac
rate
Jaundice
Icteric sclerae
Slightly globular
abdomen
Hepatomegaly
Splenomegaly
LABORATORY RESULTS
 LABORATORY RESULTS

Hematolo
gy
Decreased RBC
Decreased Hemoglobin and
Hematocrit
Decreased WBC
Normal differential count
Normal platelet count
PBS:
normocytic, hypochromic RBC
morphology
No nucleated rbc
Decreased WBC predominated by
segmenters
 LABORATORY RESULTS

Chemistr
y
Increased bilirubin
Increased LDH
Increased ALP
Increased AST and ALT
Abdominal
Ultrasound
 Abdominal
Ultrasound

Hepatosplenomegaly
Acute Hepatic parenchymal
disease
Thick-walled gallbladder with
sludge formation
Normal biliary tree, pancreas,
kidneys, urinary bladder and
prostate
Minimal ascites
DIFFERENTIAL DIAGNOSIS
 DIFFERENTIAL DIAGNOSIS
Lymphoma
(probably Hepatosplenic T cell )
RULE IN RULE OUT
Lymphoma RULED OUT!
Hepatosplenomegaly No history of immunosuppression
Young adult or immunosuppressive therapy
No historyNoofthrombocytopenia
Male preponderance (9:1.1-M:F immunosuppression(correlates
ratio) with disease progression)
Jaundice or immunosuppressive therapy
No blasts seen on PBS or
Anemia No thrombocytopenia
irregularities on (correlates
nucleus and
Leukopenia cytoplasm
with disease morphology
progression)
Fever
Weight loss No blasts seen on PBS or
Abdominal discomfort irregularities on nucleus and
Wasting cytoplasm morphology
Increased ALT, AST, ALP, LDH
 DIFFERENTIAL DIAGNOSIS

Hepatitis
Hepatitis RULED OUT!
RULE IN RULE OUT
No history of nausea and vomiting
Lateral neck Hyperbilirubine
No evidenceNo of
history
sourceofof
nausea and vomiting
infection
mass (cervical mia No historyNoof evidence of source
acetaminophen of infection
toxicity
lymphadenopath Anemia No historyNo of history of exposure
pesticide acetaminophen
y) Increased toxicity
ALP, picture
Normal of PBS
Icteric sclera No history of pesticide exposure
AST, ALTNo skin rashes
Deep yellow Prolonged Normal picture of PBS
Non reactive HBSAg
urine prothrombin No skin rashes
No relative lymphocytosis
General body time Non reactive HBSAg
No thrombocytopenia
No relative lymphocytosis
weakness Decreased
Lack of hepatitis panel and serologic tests
No thrombocytopenia
Jaundice albuminNon
levelavailability of autoantibody titers
Lack of hepatitis panel and
RUQ pain Lack of specific gamma globulin levels
Increased serologic tests
Weight loss globulin level Non availability of autoantibody
 DIFFERENTIAL DIAGNOSIS
Sarcoidosis
(probably hepatic)

RULE IN RULE OUT

Cough Sarcoidosis RULED OUT!
Erythema nodosum
Fatigue Arthritis
Chest pain ErythemaSwelling
nodosumof the parotid gland
Crackles Facial palsy
Arthritis
Fever
Jaundice
Swelling of the parotid gland
Right Upper Quadrant PainFacial palsy
Hepatomegaly
Splenomegaly
Increased ALP, AST, ALT
Decreased A:G ratio
MILIARY TUBERCULOSIS

RULE IN!
Right upper quadrant pain
Non-specific symptoms (fever, anorexia,
weight loss)
Non-specific pain abdomen
Jaundice
Hepatomegaly
 MILIARY
TUBERCULOSIS
PATHOPHYSIOLOGY
 Miliary
Tuberculosis
HEMATOGENOUS
SPREAD Non-specific
constitutiona
l signs and
LEFT symptoms
fever
AXILLARY and Weight loss
General body weakness
LEFT
LATERAL
NECK MASS
(lymphadenop
athyresolved
 Miliary
Tuberculosis
HEMATOGENOUS
SPREAD

LEFT AXILLARY
and LEFT
LATERAL NECK
MASS
LIVER
(lymphadenopathy
-resolved)
Bipedal edema
Discoloration of eyes
with deep yellow urine
Hepatomegaly
Increased AST and ALT
Decreased Albumin
Increased Globulin
Decreased A:G ratio
Increased LDH
 Miliary
Tuberculosis
HEMATOGENOUS
SPREAD

LEFT AXILLARY
and LEFT
LATERAL NECK
LIVER GALLBLADDER
MASS
(lymphadenopathy
Bipedal edema (probably Acute
Discoloration of eyes
-resolved)
with deep yellow Cholecystitis)
urine Increased ALP
Hepatomegaly
Increased AST and Increased Bilirubin:
ALT
Decreased Albumin
Direct
Increased Globulin Thick-walled gallbladder
Decreased A:G ratio
Increased LDH with sludge formation
 Miliary
Tuberculosis
HEMATOGENOUS
SPREAD

GALLBLADDE
LIVER
SPLEEN
LEFT AXILLARY
and LEFT LATERAL R
NECK MASS
(lymphadenopathy-
resolved) Splenomegaly
 Miliary
Tuberculosis
HEMATOGENOUS
SPREAD

GALLBLADDE
SEVER
E
LIVER R

SEPSISACUTE
RESPIRATORY
DISTRESS
Bibasilar
crackles
Difficulty of
Breathing
 Miliary
Tuberculosis
HEMATOGENOUS
SPREAD

GALLBLADDE
LIVER R
SEVERE SEPSIS

ACUTE RESPIRATORY
DISTRESS

DEATH RESPIRATO
RY FAILURE
Immediate cause of death:
RESPIRATORY FAILURE

Antecedent cause of death:

ACUTE RESPIRATORY
DISTRESS SYNDROME
Underlying cause of death:
MILIARY TUBERCULOSIS
THANK YOU!
 GROUP 10
Andres, Jerome
Aquilizan, Anne
Castro, Danilo
Begonia, Jennifer
Jha, Neha
Modi, Shreenath
Pascua, Kevin
Pasion, Geraldine
Parong, Ma. Stephanie
Rivera, Sarah Jane