Lymphoma case study one
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In Chief: Apranta Deka Patel, M.B.B.S, M.D.
Case #1
Case Presentation
A 77-year-old woman with past medical history of hypertension, diabetes mellitus, autoimmune hepatitis, liver transplant who presented to the Emergency Department for symptoms of worsening dyspnea on exertion progressing to shortness of breath at rest and pleuritic chest pain over the course of three months. Review of systems was otherwise negative.
Her home medications included tacrolimus, mycophenolate, amlodipine, valsartan, metoprolol, atorvastatin, metformin, glipizide and levothyroxine.
Past Medical History
Other than what is mentioned above, her autoimmune hepatitis was complicated by liver cirrhosis for which she had an orthotopic liver transplant four years prior to this presentation. Hepatocellular carcinoma and mixed cholangiocarcinoma were found on the explant with no evidence of spread. Post-transplant course was otherwise uncomplicated on stable doses of immunosuppresants, tacrolimus and mycophenolate.
Physical Examination
Vitals were stable with blood pressure of 155/100 mmHg, heart rate of 87 /min, mild tachypnea and oxygen saturation of 98% on room air. No pallor, icterus or palpable lymph nodes. Lung, abdominal and neurologic exam was normal. No pedal edema or jugular venous distension. Heart sounds S1 and S2 were normal without any murmurs, added sounds, rubs or gallops.