A 37-year-old man is hospitalized because of fever and right-sided chest pain. He has been having fatigue and recently developed dyspnea on exertion and intermittent chills. At the age of 29 years he was diagnosed with stage III Hodgkin"s disease and treated with multiagent chemotherapy and radiation therapy. A year ago, he developed mild anemia with no obvious cause. He takes thyroid hormone replacement when he remembers and has used fexofenadine as needed for allergic rhinitis for the past 5 years. On physical examination, his temperature is 38.7 °C (101.7 °F), pulse rate is 112/min, and blood pressure is 110/70 mmHg. There is dullness at the right lower lung and egophony. The hemoglobin is 8.5 g/dL, hematocrit is 26 %, leukocyte count is 2200/?L,and platelet count is 70,000/?L. What is the most likely diagnosis?
A)Relapsed Hodgkin"s disease
B)Sepsis
C)Hypothyroidism
D)Secondary myelodysplastic syndrome
E)Drug-induced bone marrow suppression

Question

Quizplus · Accepted Answer

The patient's history of multiagent chemotherapy and radiation therapy for Hodgkin's disease, along with the presentation of pancytopenia (anemia, leukopenia, and thrombocytopenia) a significant time after treatment, suggests secondary myelodysplastic syndrome (MDS) as the most likely diagnosis. MDS can occur as a late complication of chemotherapy and radiation therapy.

A 37-Year-Old Man Is Hospitalized Because of Fever and Right-Sided