A 43 year old Korean timber merchant was admitted with the chief complaints of
easy fatigability, tenderness on the left upper quadrant of abdomen and brownish
pigmentation of face skin, of 6 months duration. About 3 years prior to admission he
had an operation of hemorrhoidectomy and history of narcotic addiction.
Physical examination
The skin was dirty brown in color. The left upper quadrant of abdomen was
moderately tender and the spleen was 4 finger breadth palpable below the left costal
margin and the liver was 2 finger breadth palpable below the right costal margin. The
body temperature was 37.2℃.
Laboratory studies
Admission blood studies disclosed the following: Hb. 8.0 gm. per 100 ㎖., R.B.C. 315
mil. per cu. ㎜., Reticulocyte 14%, W.B.C. 5,000 per cu. ㎜., Diff. count (per cent),
neutrophils 82, lymphocytes 18, platelets count 104,000 per co. ㎜., Red Cell morphology
revealed, hypochromia (+), anisocytosis (+), poikilocytosis (+), target cell (+).
Bone marrow examinations revealed hypercellular marrow with erythroid hyperplasia
and many clumps of micro-organism which were identified as Flavobacterium species.
Blood cultures also revealed positive cultures of Flavobacterium species.
Progress
Anemia, splenomegaly, and hepatomegaly were disappeared with terramycin and
steroid therapy. No blood transfusion was given.
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