Case 3

The patient is a 38 year old man who had a LRD kidney transplant in 1983 because of congenital hydronephrosis. He was hospitalized because of worsening anemia discovered during a routine clinic visit. He had been somewhat more fatigued recently. He had a flu-like febrile illness within the past month, but is no longer having any fevers. Both of his children had had a brief febrile illness with an associated skin rash prior to this. There was no history of bleeding. Review of systems showed a recent 7 lb weight loss.

PAST HISTORY:

1. Status post LRD renal transplant 1983. His renal function has been declining slowly for the past two years.
2. Historyofrecurrentsinopulmonaryinfectionstreatedwithvarious antibiotics for the past several months.
3. Recurrentwartsandskincancers

Medications:
1. Mycophenolate1gramb.i.d. 2. Prednisone 10 mg daily

Social History: Married, three children. Former smoker (1 ppd). No alcohol. Works as car salesman.

Family History: Negative for blood disorders or kidney disease. Mother with MS. One child with asthma.

Review of systems: Bitemporal headaches intermittently for past few weeks. Occasional constipation. Otherwise negative.

Physical Exam: A slender (118 lb) man in no apparent distress. Normal vital signs. No lymphadenopathy. Head and neck normal, no scleral icterus. Diffuse pulmonary wheezes and a few crackles at the lung bases. Normal heart. Abdomen normal without hepatosplenomegaly, no bruits. No peripheral edema. Numerous warts.