Today we discussed the case of an HIV positive man presenting with "L flank pain" found to have anemia, splenomegaly, and a left renal vein thrombosis.
There are many learning points from this case:
The differential diagnosis for splenomegaly:
- Reticuloendothelial hyperplasia (chronic hemolysis, sickle cell, thal major)
- Infection-related hyperplasia (including HIV, EBC, CMR, TB, malaria, MAI)
- Autoimmune hyperplasia (SLE, RA - known as Felty's syndrome when neutropenia present)
- Malignancies (myeloproliferative, leukemia, lymphoma, myeloma, amyloid)
- Granulatomous disease (Sarcoid, TB)
- Congestion (Cirrhosis, CHF, portal or splenic vein thrombosis, schistosomiasis)
- Infiltration (storage diseases)
The rational clinical exam for splenomegaly (see here) that suggests that palpation and percussion are most helpful if your pretest probability is >10%
The clear association between HIV and lymphoma, most commonly high-grade B-cell non-Hodgkin's lymphoma. However, increasingly we are seeing more and more Hodgkin's lymphomas in HIV+ patients as well. See here for more details.
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