Why it's important to get checked out when flu-like symptoms don't subside | Dr. Kube
As we usually see at the start of fall, there is a noticeable increase in patients coming to the emergency department complaining of influenza-like symptoms along with a rise in COVID-19.
Mary came to the ER with various vague symptoms. She hadn’t been feeling well for several weeks with severe fatigue and poor appetite.
When her symptoms first started, she had a mild sore throat and non-productive cough. She saw her family physician after just a few days of symptoms and tested negative for flu and COVID.
Read More: Why it's important to carry an Epipen if you have serious food allergies
She also had a normal chest X-ray, and her doctor told her that her symptoms were likely due to another type of virus and to rest, drink plenty of fluids and use Tylenol or ibuprofen. Mary went back to work after several days and was feeling a little bit better for a day or two.
Then she noticed she was extremely fatigued in the evening after going to work.
She figured she just needed more rest. She was napping in the evenings and on the weekends and had started to lose some weight because she wasn’t eating as much as she normally did.
She acknowledged that some days she really had forgotten to eat and had not realized it because she had not been hungry.
She continued like this for a few weeks, and her husband began to worry about her. She called her doctor’s office to see if they could see her again and they set up an appointment for early the next week.
Her husband started to notice that Mary looked pale and she had developed numerous bruises on her legs and arms. He decided to bring her to the emergency department because he did not feel she should wait until the following week to see her doctor again.
When I saw Mary in the emergency department, she was pale and fatigued.
I did notice the bruises her husband had seen on her legs; a few of them were on her shins where it would not be unusual to have bruising from bumping against things. There were several larger bruises on her thighs above her knees that were more unusual. I asked her if she had noticed any bleeding from her gums, which she had seen occasionally after brushing her teeth.
I didn’t see any areas of bleeding in her mouth when I examined her. I did notice that many of the lymph nodes in her neck were abnormally swollen and she looked generally ill.
I wasn’t exactly sure what was going on at this point, but I ordered multiple tests to try to figure out what was going on with Mary. I was worried about her and was glad her husband decided to bring her in to the emergency department.
Mary’s COVID and flu swabs were back first and were both negative.
Her chest X-ray did not show any signs of pneumonia. Her blood work took a while to come back from the lab because it was abnormal, and the lab was double checking the abnormalities.
The lab technician called me to tell me that Mary’s red blood cells and platelet counts were very low, and her white blood cell count was abnormally elevated. They were running additional tests on her blood, but they were concerned that these lab abnormalities could be indicative of a type of leukemia.
Read More: Excess antidiuretic hormone can cause low sodium levels, seizures | Dr. Erika Kube
Leukemia is a cancer of the blood-forming tissues in the body, including bone marrow. There are numerous types of leukemia, and some forms are slow growing while others are rapidly growing.
Treatment is highly variable and based on the type of leukemia that the patient has.
For slow-growing leukemias, close monitoring may be all that is necessary. For aggressive leukemias treatment may include chemotherapy, radiation, and even stem-cell transplantation.
Mary was admitted to the hospital to undergo further lab testing and evaluation.
She was seen by the hematologist and oncologist and had a bone marrow biopsy done the following day. This is a procedure where a needle is used to remove a sample of bone marrow, which is sent to the lab to be analyzed for leukemia cells.
Within a few days, Mary had been diagnosed with Acute Lymphoblastic Leukemia (ALL) which is characterized by the development of large numbers of immature lymphocytes. Lymphocytes are a type of white blood cell that is part of the immune system that helps your immune system fight cancer, foreign viruses, and bacteria.
ALL is rare in the United States, accounting for only 1% of cancers in the US. The risk of developing ALL is higher in children under 5 years of age and most cases of ALL occur in children, however, most deaths due to ALL occur in adults rather than children.
The main treatment for ALL is chemotherapy but depending on the results of additional testing on Mary’s specific type of ALL, her treatment could include targeted cancer drug immunotherapy or a stem cell or bone marrow transplant.
While hospitalized, Mary had a port placed through which she received her chemotherapy. A port is a small implantable reservoir with a thin silicone tube that attaches to a vein and allows access to the blood stream without having to endure repeated needle sticks in the vein.
She had close follow up scheduled with her specialist physicians and would undergo additional chemotherapy while her specialist devised a full plan for how to treat Mary’s ALL.
Dr. Erika Kube is an emergency physician who works for Mid-Ohio Emergency Services and OhioHealth.
drerikakubemd@gmail.com
This article originally appeared on The Columbus Dispatch: Dr. Kube: Visit the ER if flu-like symptoms get worse, drag on
