Neutropenia and Splenomegaly

Today, we discussed a HOT case of acute on chronic cough after a visit to Yuma, AZ 4 years ago associated with fevers, night sweats,  25 pound weight loss in the setting of reportedly long-standing leukopenia of uncertain etiology, found to have fever to 102, splenomegaly, multiple groundglass nodules on CT chest, scattered moderate lymphadenopathy,  and pancytopenia with ANC 1100, overall concerning for possible underlying myeloproliferative disorder with infectious (fungal?) cough . Along the way, we discussed the differential for splenomegaly and neutropenia. 

Massive splenomegaly. 

Massive splenomegaly. 

The causes for splenomegaly are numerous (CHIIIM mnemonic): 

  • Congestive: cirrhosis, heart failure, thrombosis of the splenic/hepatic veins 
  • Hematologic: hemolytic anemias, sickle cell, gCSF use
  • Infection: fungal, viral (mono, CMV, hepatitis), parasitic (malaria, toxo, etc), bacterial (TB, salmonella), endocarditis
  • Inflammation: SLE, RA (Felty's), sarcoidosis
  • Infiltrative: amyloidosis, HLH, Langerhans cell histiocytosis, Gaucher's...
  • Malignancy: lymphomas, leukemias, polycythemia, vera, essential thrombocytosis, myelofibrosis

The workup for unexplained neutropenia from an article in Blood August 2014 is summarized here