68-Year-Old Man With Neutropenic Fever and Upper Extremity Hematoma

Abstract

A 68-year-old man was transferred to our institution from an outside hospital because of ongoing daily fevers. His medical history was notable for stage IVB diffuse large B-cell lymphoma (DLBCL), diagnosed 2 months previously. The patient was admitted to the outside hospital 3 days after receiving the second cycle of R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Vital signs were normal with the exception of a temperature of 39.4°C. Physical examination findings were remarkable for a 9×3-cm hematoma on the left upper extremity at the site of intravenous (IV) infiltration from a previous hospitalization and a healing stage II decubitus ulcer. Laboratory studies revealed the following (reference ranges shown parenthetically): hemoglobin, 7.4 g/dL (13.5-17.5 g/dL); leukocyte count, 0.4 × 109/L (3.5-10.5 × 109/L); platelet count, 12 × 109/L (150-450 × 109/L); alkaline phosphatase, 275 U/L (45-115 U/L); creatinine, 0.6 mg/dL (0.8-1.3 mg/dL); lactate dehydrogenous, 229 U/L (122-222 U/L); and normal levels of aspartate aminotransferase, alanine aminotransferase, and total bilirubin.