Really interesting case, never seen that yet but we get about 1-3 per year it seems through one of the hospitals I work at.
I see loads of weird stuff, not always super interesting, but I’ll start writing things down for you Rusted. I just forget usually as it all runs together for me. I’ve been told pathology has called our department extremely rarely. One doc I work with says he knows of them calling the ED 3 times in 14 years. I’ve personally spoken with them twice… But here’s a reasonably recent case, second pathologist call I’ve received, I should probably follow up on it:
Mid 40s poorly controlled diabetic comes in for abdominal pain. Started 2-3 weeks ago. Went to urgent care first, they drew labs, freaked out when they got the results and sent the patient immediately to the ED. Pain is in left upper quadrant, no other symptoms really aside from some pain also in the left shoulder. Has taken Motrin and Tylenol (which I swear no one ever even tries before they come in and are offended when I give it to them and then it works!!!), eating and drinking fine. Abdominal exam is very benign, very slight LUQ tenderness but patient also is obese so not a great exam. Hm… let’s look at those labs the midlevel didn’t know what to do wi… huh. 100k WBCs. Rest of major cell lines fine. The differential was mostly neutrophils but had various other cell types, no or few blasts, so thinking leukemoid reaction. But still, can’t really ignore that… CT scan shows either areas of infarction or developing abscesses in the spleen. Huh. Whelp, zosyn and admit. Pathologist calls nervously and states he can’t definitively rule out leukemia, so get more draws and diffs, but he is pretty sure it is leukemoid reaction. Path starts out by describing the things they’re seeing on the slide, as if I took cell bio within the past year (not almost ten years ago now) and as if I paid attention in that class (definitely not). Get to the point man!!! But it is nice being called for once and not having to page someone, although I was confused as F when they overheaded me to the desk for a call.
Patient asked if they could eat the Burger King they got on the way over to the ED when I went in to relay the CT scan results. Also was shocked that I was recommending admission to the hospital.
Still don’t know if it was a leukemia causing hyperviscosity and splenic infarction, or if it was poorly controlled diabetes leading to a splenic infection and then abscesses. I did my ID attending from med school proud and had asked earlier about travel or weird foods, which was a negative. IM took over and I know they were getting ID on board, considering gen Surg as well. Haven’t been back there for a couple weeks so I’ll update if anything interesting comes of it. Kerr sign isn’t super common but was cool to see in real life. Usually think about it with trauma, not very often in a medical type complaint.
