Prepared by Raman Battish, MD, Resident, Department of Medicine, Eric Choi, MD, Resident, Department of Medicine, Josh Lloyd, MD, Resident, Department of Pathology, and Jonathan E. Gottlieb, MD, Associate Professor, Department of Medicine, Thomas Jefferson University Hospital Philadelphia, Pa
A 98-year-old woman living alone was found at home after not answering her phone for several days. She had lost weight in the preceding 4 months, and her behavior had become erratic. Physical examination showed she was confused, afebrile, and hypotensive. She was treated for urinary sepsis. Complete blood cell count revealed: neutrophilia and lymphopenia; leukocyte count, 8.0 x 109/L, with 93% neutrophils and 4.7% lymphocytes. Repeat liver function tests showed elevated levels of alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase. Her oxygenation was mildly abnormal. Her initial chest x-ray was abnormal (Figure 1). She developed renal failure and died 1 week after admission. Autopsy findings are shown (Figure 2).
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