A previously healthy 17-year-old female presents with scleral icterus, dizziness, and headache. She has had 2 days of diarrhea and nausea preceding her presentation. She also reports a single episode of syncope at home yesterday. Family was unsure of time down because it was an unwitnessed event; however, the patient woke up confused but otherwise neurologically intact. She presented to the emergency department for evaluation given continued symptoms.

Examination is pertinent for obvious scleral icterus as well as pronounced splenomegaly.
Laboratory results were as follows:

• CBC: Hgb 6.3 g/dL, WBC 9.15x10³/mcL, platelets 162x10³/mcL, MCV 96.3 fL, RDW 13.9%
• Reticulocyte count: 8.36%
• LFTs: bilirubin 8.3 mg/dL, indirect bili 7.3 mg/dL
• CRP: 0.7 mg/dL; ESR 138 mm/h
• BMP normal

Based on the clinical presentation and laboratory evaluation, what is your leading differential diagnosis?
Take the quiz.

Shailly Gaur, MD, and Michael Silvey, DO
Division of Pediatric Hematology Oncology & BMT
Children’s Mercy Hospital
Kansas City, MO

Details

Categories: Case Quiz