- Neutropenia in a hospitalized patient:
- Think of drugs (including chemotherapy, penicillin, cephalosporins), infections (especially viral EBV, CMV, hepatitis, HIV, influenza), bacterial infections, mycobacterial, fungal etiologies, malignancy, sequestration (hypersplenism), and rheumatologic causes
- Neutropenia in rheumatologic diseases: common in lupus, rheumatoid arthritis (Felty’s syndrome includes RA, splenomegaly, and neutropenia), Sjogren’s, polymyalgia rheumatic, and mixed connective tissue disease
- PE: left untreated, PE has an overall mortality of up to 30 percent. Most deaths occur during the first week following diagnosis and are due to recurrent venous thromboembolism and shock.
- Limited cutaneous scleroderma: typically sclerosis of the hands, face and neck. May have CREST (Calcinosis Cutis, Raynaud, Esophageal dysmotility, Sclerodactyly, and Telangiectasia)
- Anti-centromere antibodies are highly specific in distinguishing systemic sclerosis patients from healthy individuals (99.8-100%) or patients with other connective tissue diseases (96-100%), it is strongly associated with limited cutaneous scleroderma, although a small percentage will develop diffuse systemic sclerosis (5-7%)
Munshi HG and Montgomery RB. Severe neutropenia, a diagnostic approach. West J Med 2000. 248-253.
Nihtyanova SL and Denton CP. Autoantibodies as predictive tools in systemic sclerosis. Nat Rev Rheumatol. 2010 Feb; 112-6.