Painful Lesions in a Pancytopenic Patient

Ms. P is a 46-year-old female who visited a walk-in clinic with a two- to three- week history of flu-like symptoms that included a fever higher than 38.5 C (102 F), chills, and night sweats. She also was experiencing anorexia and fatigue and reported a 15-pound weight loss. She added that her children had been sick with the flu during this time. She was placed on a seven-day course of antibiotics and told to return to the clinic after completion of the antibiotics. One week later, the symptoms persisted and she developed shortness of breath and increasing fatigue. At the clinic, a chest x-ray and complete blood count were performed. An elevated white blood count (109,000/mm3) prompted the physician to immediately refer her to an oncologist in the area. She then was transferred to the medical center with a tentative diagnosis of acute leukemia.