The next case is a 65 year old gentleman, who was admitted to hospital complaining of weight loss and nausea. Endoscopy revealed a superficial duodenal ulcer and low grade oesophagitis. Medical treatment was commenced, but the patient continued to have abdominal pain, and a subsequent liver ultrasound scan showed small abnormal areas in the liver suggestive of metastatic disease. Liver biopsy showed extramedullary haemapoesis and features consistent with a non-Hodgkin's lymphoma or acute lymphoblastic leukaemia.
The patient underwent a course of chemotherapy and was admitted complaining of sudden weakness and numbness in the right side of his face. No other neurological signs or symptoms were present, and the weakness resolved spontaneously over next 4 days./
One month later the patient complained of generalised weakness, and also became pyrexial. His White Cell Count and Haemoglobin levels fell. A subsequent blood culture grew coliforms (bacteria commonly found in the GI tract). Following this, there was a rapid deterioration despite medical intervention and the patient unfortunately died.