Abdominal Pain and Splenomegaly

This is a case study regarding a 37-year-old male with no significant medical history who presented with progressive, nonradiating, bilateral abdominal discomfort. The patient noted a tender hot spot in his left lower quadrant. Review of symptoms revealed unintentional weight loss of 20 pounds and generalized itching exacerbated by showers or swimming. Notably, he had a history of elevated white blood cell counts. His abdominal exam was significant for a left-upper quadrant and left-lower quadrant palpable mass that was nonreducible, nontender, and nonpulsatile. Computed tomography findings were significant for an enlarged liver and a severely enlarged spleen with the tip extending out of the field of view into the pelvis. Hematology recommended additional lab work and bone marrow sampling. Bone marrow aspirate and biopsy showed myeloproliferative neoplasm with a hypercellular marrow and bizarre atypia, and increase in reticulin fibrosis. Hematopathology report based on bone marrow biopsy concluded that the reported complete blood count data and bone marrow findings favored a diagnosis of primary myelofibrosis. 

This case highlights the significance of thorough history-taking and physical examination in assessment of abdominal complaints, and the importance of a systematic approach to clinical evaluation. Further investigation, such as lab work and imaging, confirms the diagnosis and guides the treatment plan.