A previously healthy 32 year old man presented to an emergency room with malaise, fever, crampy abdominal pain and diarrhea x 2 days, and bloody stools x 1 day. His CBC showed a WBC of 14,000, Hgb 16.4, platelets 206,000, creatinine 0.9, LFTs normal. He had various cultures done and was given ciprofloxacin x 5 days. One week later he presented with weakness and lightheadedness, such that he had trouble getting out of bed. He had continued to note bloody stools. His temperature was 102.7 F and he was icteric. He was anemic and thrombocytopenic and was given two units of PRBC prior to transfer here. Serum creatinine was 2.2.
Past History: He had an episode of severe gastroenteritis as a child that required hospitalization. He had a peritonsillar abscess drained as an adolescent.
Medications: Vicodin p.r.n. and pantoprazole.
Family Hx: Father with cerebral aneurysm, HTN. Mother A&W. Maternal grandfather with lung CA. Maternal grandmother and paternal grandfather with MI.
Social Hx: Married, no children. Desk job. Quit smoking 3 mo ago, 2-3 beers per night. No illicit drugs. No pets.
Physical examination: Temperature 37.8 C, other vitals normal, SaO2 98% on RA. Alert and oriented. Not icteric. No focal neuro deficits. No bruises or petechiae. Exam otherwise normal.
CBC and differential
Bone marrow biopsy
Platelet function screen
Factor II, X, V, VII, IX, VIII, XI, XII, XIII
Activated protein C resistance
Factor V Leiden
Prothrombin gene mutation
Lytes, glucose, creat, BUN
Alk phos, GGT, bili
Albumin, total protein
Helical chest CT
Other pathology (biopsy)