Topic: blood clotting
a 19 year-old female patient refers 39 °c afternoon fever 10 days before , accompanied by sweats and chills, throat pain. five days later she presented epistaxis, gum bleeding and purpur spots on the legs, bilateral neck adenopathies..
physical examination: t39’c bp 110/70 mm hg hr 100bpm good general appearance. skin reveals a purpuric petechial exanthem mainly in lower extremities and milder in chest and abdomen. erythematous oropharynx, hypertrophic tonsils and few white plaques. bilateral cervical firm 0.5 fo 1 cm adenopathies were present . abdomen with 1.5 cm smooth painless hepatomegaly and 2cm splenomegaly. rest of the examination unremarkable.
lab> hb 14 g/l, hct 44 %, leukocytes 13 500 x 10-9/l, neutrophils 25% lymphocytes 61% monocytes 14 % , peripheral blood smear revealed abundant lymphomonocytes, increased esr. glycemia, uric acid, fhp, renal and pancreatic tests were unremarkable. total protein: 8.8 g%; albumin 60 %; alfa 1 5 %, alfa 2 12 %; beta 14 %; gammaglobulins 16 %. bleeding time 2min, clotting time 8min, prothrombin time c–14 t –15, partial tromboplastine time 42seg, platelettes : 40 000 x 10-3 /l; clot retraction: null. ana, cryoglobulin, inmmunecomplex and complement normal. paul–bunnell–davison positive 1/364. indirect inmmunofluorescence for epstein barr capside positive 1/728 for ig g and igm. bone marrow smear revealed hyperelularity megakariocytes mildly elevated in number some bizarre and immature.
what is the diagnosis and what is the disease?
name what organs are affected.