446) A 64 year old woman presents to your office with productive cough and fever for the past three days. About two months ago, she was admitted for pneumonia. Past medical history is significant for Rheumatoid arthritis. Her medications include hydroxychloroquine and prednisone. Previously, she was treated with Azathiprine for about 6 years.
On examination, temperature is 101F, blood pressure 120/80 and heart rate of 106/min. Chest examination reveals decreased breath sounds at left lower lobe. No hepatomegaly, spleen tip is palpable. Chest X-Ray reveals left lower lobe consolidation Labs reveal WBC 1000/µl with differential count showing neutrophils of 30% and Hemoglobin 9.9 gm%
Which of the following is the most likely explanation for the patient’s presentation?
A) Hypogammaglobulinemia from Rheumatoid arthritis
B) Marrow suppression by Hydroxychloroquine
C) Marrow toxicity by Azathiprine
D) Myeloproliferative disorder
E) Felty Syndrome
Filed under: Uncategorized, USMLE Test Prep | Tagged: archer general internal medicine, Archer hematology, Archer Rheumatology, Hematology, usmle hematalogy, USMLE step 3 Hematology, USMLE step 3 Rheumatology | 14 Comments »