Abstract
Case Presentation A 70-year-old female went to her rheumatologist for a routine follow-up visit for rheumatoid arthritis and Sjogren’s syndrome on October 17, 2000. At that time, she did not have any complaints apart from her baseline medical conditions. The patient did have several other medical conditions including osteoporosis, hypothyroidism, depression, hypertension, and hypercholesterolemia. The medications she was taking included Plaquenil, Ketoprofen, Sulfasalazine, Artificial Tears, Fosamax, Caltrate, Synthroid, Prozac, Norvasc, Atenolol, and Lipitor. A routine complete blood count (CBC) demonstrated a white blood cell count (WBC) of 29,400/μl. Her previous CBC (in June 2000) demonstrated a WBC of 10,900/μl. She was referred to an oncologist where she reported no fevers, bleeding, or other symptoms. Analysis of her bone marrow determined that she had a blast count of less than 1% and that blasts and promyelocytes made up less than 10% of the cells seen. The immunophenotype by flow cytometry found that 92% of cells had mature granulocytic elements and also exhibited an aberrant expression of CD56. Cytogenetic testing was performed in addition to morphologic analysis of her blood and bone marrow to determine her diagnosis.
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