A 63-year-old man presented with shortness of breath on exercise and loss of weight. He had suffered five chest infections during the previous winter. Examination On examination, there was moderate, bilateral cervical lymphadenopathy and left inguinal lymph node enlargement. The spleen and liver were enlarged 5cm below the costal margins.
There was no bone tenderness and there were no lesions in the skin. Clinical investigation On investigation, his haemoglobin (133g/l) and platelet count (252 x 10 9 /l) were normal but his white-cell count was increased to 149 x 10 9 /l; the film showed that 98% of these were small lymphocytes. Ninety per cent of the cells were B cells; they all expressed surface immunoglobulin (mu, delta and kappa chains), major histocompatibility complex class II antigens (DR) and CD5. The serum immunoglobulins were low: IgG 2.2g/l (NR 7.2-19.0g/l); IgA 0.6g/l (NR…
