Fatigue and Splenomegaly

🗒️ Question

A 68 year old man presents to his GP with a three month history of fatigue, night sweats and unintentional weight loss. He also reports frequent respiratory tract infections. His past medical history includes hypertension controlled with amlodipine.

On examination, there is generalised lymphadenopathy and mild splenomegaly. No hepatomegaly is noted.

Investigations

• Haemoglobin: 115 g/L (130–180)

• White cell count: 65 × 10^9/L (4.0–11.0)

• Lymphocytes: 55 × 10^9/L (1.1–3.3)

• Platelets: 150 × 10^9/L (150–400)

What is the most appropriate diagnosis?

(A) Acute lymphoblastic leukaemia

(B) Chronic lymphocytic leukaemia

(C) Hodgkin lymphoma

(D) Non-Hodgkin lymphoma

(E) Infectious mononucleosis