Episode 1: Dr. Fajgenbaum’s Commentary

• Within a few weeks, patient went from being healthy young adult to being hospitalized in ICU
• Notable symptoms in 3-week span:
  • Severe constitutional symptoms, ie, fatigue, night sweats, nausea, vomiting, weight loss, noted pitting edema and fluid overload, and eruption of cherry hemangiomas
  • Hemangiomas appeared and erupted within days and went from small little capillaries to large cherry hemangiomas
  • Patient hospitalized for severe renal dysfunction, liver dysfunction, and pancytopenia
  • Patient taken to ICU, where he experienced retinal hemorrhage and began to gain tremendous amount of fluid
  • Gained >30 pounds of anasarca of fluid, while losing weight, and could not eat due to intense nausea and vomiting
• Early in ICU, doctors suspected acute mononucleosis EBV infection
  • That was rescinded when there was positive IgG test for EBV
• Lupus diagnosis made, based on low positive ANA and clinical features
  • Patient administered very high-dose steroids, and experienced tumor lysis syndrome
  • No hot lymph nodes on PET scan, which then caused team to rescind lupus diagnosis
• Lymphoma suspected
  • Bone marrow biopsy performed, which was uninformative and displayed reactive changes
  • Nothing represented cancer within bone marrow
• Patient received very high doses of steroids and 3 different diagnoses, but by end of hospitalization, had no definitive diagnosis
• After 7 weeks of high-dose steroids, he began to improve and was discharged without diagnosis

Read through the episodes of one patient’s journey toward an accurate diagnosis and listen to an expert’s analysis on each episode.