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JAMA Surgery Clinical Challenge
August 2014

Young Woman With Massive Splenomegaly

Author Affiliations
  • 1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Surg. 2014;149(8):869-870. doi:10.1001/jamasurg.2013.3209

An otherwise healthy woman in her early 20s was referred to our general surgery clinic for massive splenomegaly after developing a migratory, urticaric maculopapular rash over her body earlier in the year. On physical examination, the inferior tip of the spleen extended well below the costal margin into her left lower quadrant. In addition to the rash and splenomegaly, the patient also described several months of fatigue, early satiety, and back pain. However, she denied other constitutional symptoms such as fevers, night sweats, chills, arthralgias, or weight loss. She did not have any personal history of mononucleosis, Lyme disease, arthritis, or bleeding disorders. In addition, there was no family history of hematologic diseases or lymphoma. Findings from a hematologic workup were unremarkable. Cross-sectional imaging was performed (Figure 1).

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