A 79-year-old man with a smoking history of 100 pack-years was hospitalized. He complained of shortness of breath and exertional palpitations, accompanied by bloody sputum, of 1-month duration associated with lethargy and loss of appetite. His past medical history included type 2 diabetes, thrombocytopenia and idiopathic atrial fibrillation.
On examination vital signs were normal. Yellow staining of the skin and sclera, liver palms were noted. Some fine rales were auscultated at the base of posterior lung fields. Abdominal palpation revealed hepatosplenomegaly and shifting dullness. The liver could be felt 3.5 cm below the costal margin on the midclavicular line and 5.5 cm below the xiphoid. The extremities examination revealed bilateral pitting oedema below the level of the knees.
Liver functions were abnormal with alanine aminotransferase. Urinary bilirubin and urobilinogen were positive. Chest HRCT, abdominal MRI, ultrasound and bone marrow biopsy were done. Immunohistochemical and haematoxylin-eosin staining produced the following results CD1a (+); S-100 (+, polyclonal); Kp-1 (+); phosphoglucomutase-1 (+); and Ki-67 (+ <25%).
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