21  YEARS OLD FEMALE PT 
KNONW TO HAVE  HYPERTHYROIDSIM AND IRON FEDDI  ANEMIA 

  SHE AHD  S KIN  RASH      A ND  VOMITING 
SHE      FOUND TO HAVE    WBC     105    AND     HGB   9      PL,  57 
CREATININE AT  THAT TIME   WAS  7      AND BUN  80 
BLOOD  FILM  SHOWED  MONOCYTOSIS    WITH LEFT SHIFT     AML    SHOWEUL  BE  R/O 


BMB   SHOWED      7%  BLAST    PICTURE  CONSISTAT  WITH CML 

URIC  ACID   37 MG/DL 
URINE CUTLRUE  WAS POSTIVE  FOR  KLEIBSELLA 


WHOLE  BODY CT WAS  DONE AND   LAP  FROM THE CERVICCAL    AND  AXILLARY     
SHE HAD   SPLEENOMEGALY 
PET  SCAN SHOWED    BILATERAL CERVICAL AND   PROMINANNT  SIZE  LN    MILD  FDG   UPTACKS AND   SUV 4 
ABDOMINAL AND PELVIC  CT WAS DONE AND   SOWED ENLARGED SPLEEN AND  FDG  UPTACKS   6.5     SPLENIC    INFEX   1351 
THERE IS  DIFFUSE  HYPERMERABOLIC   INTENSE  FDG    UPTACKS  

 S HE HAD  3 SESSION OF  HEMODIALYSIS   IN   6/2024 
CORE BIOPSY FROM THE AXIALL  SHOWED  REACTIVE AND NO MALIGNANCY 
ANA   ENA    AND   APLA      WERE  NEGATIVE 
HBSS   HCV   AND HIV  ARE NEGATIVE 
LDH   1000 

SHE AHS  HISTORY FOR RECURRENT INFECTION 
SHE AHD   HSV     HERPES  ORALIS  AND SHE HAS ALLERGY TO VALGANCYCLOVIR   AND  SHE RECEIVED  ACYCLOVIR 

SHE  HAD  BOLLOUS DISEASE AND   SEEN BY DERMATOLGIST AND SHOWED   FOUND TO HAVE PARANEOPLASTIC   BOLLOUS DISEASE 

IGE  LEVEL   153 
EASINOPHILC  COUNT        1-6 
WES  HETERZYGOUS   DUPLICATIONS   VARIAENT    OF  UNKNONW   SIGNIFICANT  POSSIBLY   CAUSATIVE FOR THE PHENOTYPES 

PCR     ABL 1  AND     GEN    24  11    2024   WAITING THE RESULT 

SHE RECEIVED  IVIG  MONTHLY  WEIGHT   80  KF 
HIGH  158 
BSA   1.99

SHE AHS BEEN MAINTAINE DOIN NILOTINIB   200 MG   2X2 


RECENTLY SHE AHS  INCREASING LOWER LIMBS  EDEMA   WITH MONTING PUFFNES A  AND URINE ANALYSIS SHWOED  +2  PROTEIN AND +1  BLOOD  

INTERSTITIAL NEPHRTIS    COULD   BE  DUE TO  NILOTINIB  INTACSKS 



URINE ANALYSIS   +2  PROTEIN  AND  +1 BLOOD
CREATININE   0.59

PLAN 
ADD   ATACAND    8 MG ONCE 
DEE  DENSE   2000  IU ONCE 