Ace the Case: A 62-Year-Old Man Presents With Increasing Fatigue, Weight Loss, and Night Sweats for the Past 8 Months
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Chief Complaints: Fatigue, weight loss, and night sweats
History of Present Illness: A 62-year-old man presents with increasing fatigue, weight loss, and night sweats for the past 8 months.
Past Medical History: Hypertension; non-smoker; non-drinker
Medications: Telmisartan 40 mg once daily
Physical Examination: Temperature: 100.5 °F; pulse: 96 beats/minute and regular; respirations: 14 breaths/minute; blood pressure: 132/80 mm Hg bilaterally. Bilateral axillary and cervical lymphadenopathy is noted. Spleen is palpable 6 cm below the left costal margin.
Labs: Hemoglobin: 8.5 g/dL; leukocyte count: 165,000/microL (85% lymphocytes, 15% neutrophils); platelets: 98,000/microL; beta-2 microglobulin: 13.6 mg/L. Flow cytometry demonstrates monoclonal Beta cells expressing CD 5, CD 10, CD 20, CD 52. Cytogenic analysis demonstrates a 17p deletion.
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Correct Answer: B.
Rationale: Chronic lymphocytic leukemia (CLL) is a monoclonal disorder characterized by progressive accumulation of functionally incompetent lymphocytes.1 Chronic lymphocytic leukemia is the most prevalent lymphoid malignancy among US adults and is the most common form of leukemia in Western countries.2,3 The American Cancer Society estimates that 20,940 new cases of CLL will be diagnosed in the United States in 2018.3,4 Most patients present with an increased lymphocyte count with or without adenopathy or splenomegaly.