LASOP Slide Seminar Case Presentationlasop.com/pgs/hdouts/2009-11_Acree.pdf · Sara Acree, M.D....
Transcript of LASOP Slide Seminar Case Presentationlasop.com/pgs/hdouts/2009-11_Acree.pdf · Sara Acree, M.D....
Sara Sara AcreeAcree, M.D. (PGY, M.D. (PGY--3)3)LAC+USC Medical LAC+USC Medical CenterCenter
LASOP Slide SeminarLASOP Slide SeminarCase PresentationCase Presentation
November 10, 2009November 10, 2009
HistoryHistory
•• Pt: Pt: 113 year3 year--old Hispanic male old Hispanic male
•• CC:CC: Fever, chills, night sweats, cough, Fever, chills, night sweats, cough, and and hemoptysishemoptysis x 1 weekx 1 week
•• PMH:PMH: NoneNone
•• PE:PE: Raised Raised petechialpetechial lesions on chestlesions on chestGeneralized Generalized lymphadenopathylymphadenopathy
•• CXR:CXR: Diffuse bilateral pulmonary infiltratesDiffuse bilateral pulmonary infiltrates
Lab StudiesLab Studies•• CBCCBC
–– HbHb 11.7 11.7 g/dLg/dL–– PltsPlts 91 x1091 x103 3 μμLL–– WBC 40.7 x10WBC 40.7 x103 3 μμLL
•• NEUT 69, LYMPH 17, MONO 13, EOS 1NEUT 69, LYMPH 17, MONO 13, EOS 1
•• Blood & Sputum Cultures:Blood & Sputum Cultures:–– Negative for aerobic, anaerobic, and acid fast Negative for aerobic, anaerobic, and acid fast
bacteriabacteria–– Negative for viral agentsNegative for viral agents
•• Viral Viral serologiesserologies negative:negative:–– CMVCMV, EBV, HSV, , EBV, HSV, HBsAgHBsAg, , HBcAbHBcAb, HCV, HAV, HIV, HCV, HAV, HIV
Flow Cytometry Flow Cytometry -- PBPBSSS
S
CD45CD45C
D14
CD
14CD13CD13
Flow Cytometry Flow Cytometry -- PBPB
CD
19C
D19
CD38CD38
CD
16C
D16
CD11bCD11b
Flow Cytometry Flow Cytometry -- PBPBC
D56
RO
CD
56R
O
HLAHLA
-- DRDR
CD3CD3 CD7CD7
Flow Cytometry (PB) Flow Cytometry (PB) -- ResultsResultsPositivePositive: : •• CD45CD45•• Subpopulation: CD7, CD11b, CD13, CD16, CD38, Subpopulation: CD7, CD11b, CD13, CD16, CD38,
CD56, CD71, HLACD56, CD71, HLA--DRDR
NegativeNegative::•• CD2, CD3, CD2, CD3, cytoplasmiccytoplasmic CD3, CD4, CD5, CD7, CD8, CD3, CD4, CD5, CD7, CD8,
CD10, CD14, CD19, CD20, CD23, CD33, CD34, FMC7, CD10, CD14, CD19, CD20, CD23, CD33, CD34, FMC7, kappa, lambdakappa, lambda
INTERPRETATIONINTERPRETATION: CD45 lymphoid process with partial : CD45 lymphoid process with partial myeloid antigen expression. CD7 on some cells may myeloid antigen expression. CD7 on some cells may reflect a Treflect a T--lineage associated phenotype.lineage associated phenotype.
Clinical Course, cont.Clinical Course, cont.
•• Day 2:Day 2: WBC doubled to 81.7 x 10WBC doubled to 81.7 x 109 9 LL
•• Day 5:Day 5: WBC doubled to 167 x 10WBC doubled to 167 x 109 9 LL
•• Day 7:Day 7: Worsening respiratory distressWorsening respiratory distressPatient Patient intubatedintubatedTransferred to childrenTransferred to children’’s hospitals hospitalStarted on ECMOStarted on ECMO
BM AspirateBM Aspirate