The case A 25-year-old male presented to his family physician ( FP ) with a 6-week history of general malaise and fatigue . He felt intermittent chills with a low-grade fever of 38 o C. The patient’s past medical history was insignificant. The physician’s note provided no details of the physical examination.
However, the routine complete blood count (CBC) and biochemical tests [glucose, creatinine, liver enzymes, and thyroid stimulating hormone (TSH)] were reported normal except for mild normocytic anemia of 105 g/L . Without any further investigation, the FP referred this patient to a hematologist . The consultant hematologist noted the detailed history of the patient and conducted physical examination with a non-diagnostic bone marrow aspiration , the results of which were normal . However, on the follow-up visit, the patient complained of a focal area of tenderness on the sole of his…
