A Febrile Patient with Polyarthritis, Visceromegaly and Cytopenias

Abstract

A case report of asymmetrical polyarthritic patient with history of fever of 6 months duration. Clinically also had hepatosplenomegaly. The lab reports revealed Cytopenias with TLC of TLC 1830μl, Hb 9.5g/dl, platelets 44000mL, and high ESR that is 75. Patient was worked up for possible SLE and RA, bone marrow biopsy was done for Cytopenias. While RA, ANF and Anti-DNA came out positive, thus bone marrow revealed hairy cell leukaemia, which was further confirmed by immuno-histochemistry. Patient was started on steroids due to painful arthritis and discharged to be followed up after two weeks and mediation for HCL. Surprisingly, the CBC report reverted significantly normal this period. Now the distinguishing point is, unlikely for hairy cell leukaemia to respond steroids so quickly within 10 days, or this was all SLE related manifestations and HCL was an incidental finding during the workup of pancytopenia. On further follow up, we will do BRAF and flow cytometry for HCL.