Question

A 64-year-old man of Jewish descent presents at the ER with a history of progressive fatigue over several years and increasing bone pain. He has firm splenomegaly and pancytopenia. Bone marrow aspiration done later on during the investigation shows infiltration with large cells with fibrillar cytoplasm.

What is the most likely diagnosis?

Answer 1

The 64-year-old man with a described symptom profile is most likely suffering from myelofibrosis, a condition that causes scar tissue formation in bone marrow, leading to extramedullary hemopoiesis and an enlarged spleen.

Step-by-step explanation:

The most likely diagnosis for a 64-year-old man of Jewish descent presenting with progressive fatigue, bone pain, firm splenomegaly, pancytopenia, and bone marrow aspiration showing infiltration with large cells with fibrillar cytoplasm is myelofibrosis. This disorder is characterized by inflammation and scar tissue formation in the bone marrow which impairs hemopoiesis. The enlarged spleen, or splenomegaly, is due to extramedullary hemopoiesis, which is the process of blood cell production outside the bone marrow, typically in the spleen and liver when the bone marrow's ability to create new blood cells is compromised.