Case 31-1983

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Abstract
Presentation of CaseA 63-year-old woman was admitted to the hospital because of abdominal pain and hepatosplenomegaly.There was a 15-year history of chronic lymphocytic leukemia treated from the time of the diagnosis with chlorambucil, 4 to 10 mg daily. White-cell counts obtained approximately every two months generally ranged between 15,000 and 23,000. Eight months before entry a nonproductive cough developed and persisted. Two months before admission the patient began to cough up clear sputum, which later became gray-green. One month before entry a physician prescribed amoxicillin. The cough improved, but several days later severe midepigastric pain developed, accompanied by . . .