Department of Pathology, University of Oklahoma Health Sciences Center

September 2005, Case 509-1. Quiz set! Click here to see.

A 73 year-old man with itchy skin rash, hepatosplenomegaly, and increased level of histamine in urine.

Clinical information:  The patient was a 73 year-old man with an itchy skin rash, hepatosplenomegaly, and gastrointestinal bleeding.  On admission, his complete blood count (CBC) showed an elevated white count (21,000/cm3) with 25% monocytes and 16% eosinophils, hemoglobin of 9.8 g/dL and 8,000 platelets/cm3.  His 24-hour urine histamine was >200 mg/mL ( ref 5.6-13.5 mg/mL). A bone marrow biopsy was performed and the representative photomicrographs are illustrated below:

Click thumbnails to see pictures.

What is your working diagnosis? What other test would you pursue to confirm your diagnosis? Discussion

Cases of the Month  Evaluation  Coordinator: KarMing-Fung@ouhsc.edu