A 34-year-old male who had recently immigrated from Cameroon presented with severe symptomatic anemia. The patient noticed bright red blood after a bowel movement, which later changed to melena. He then began experiencing fatigue and chills, followed by a syncopal episode. On examination, the patient was febrile at 38.0°C. He was also tachycardic and demonstrated conjunctival pallor. His physical examination was otherwise unremarkable. Laboratory studies revealed a microcytic anemia with a hemoglobin level of 3.9 g/dl and a mean corpuscular volume (MCV) of 75 fl, requiring the patient to receive multiple transfusions. Given the history of gastrointestinal bleeding, an endoscopy was performed, which revealed an 8- to 10-cm gastric fundal ulcerative mass determined to be a gastrointestinal stromal tumor (GIST) by biopsy. Additional workup included collection of blood smears (Fig. 1) based on the patient’s country of origin, severe anemia, and fever.
FIG 1.
Wright-stained peripheral blood smear (top) and enlarged sections of the same image (bottom left and right). For an explanation of the arrows in the bottom panels, see the answer to the Photo Quiz.
What is your diagnosis?
For answer and discussion, see https://doi.org/10.1128/JCM.01102-18 in this issue.