Presentation of Case A 63-year-old man was admitted to the hospital because of fever and diarrhea. He was well until nine years earlier, when leukocytosis and splenomegaly were found. Biopsy specimens of the bone marrow and liver were obtained, and a diagnosis of idiopathic myelofibrosis was made. Two years later, because of abdominal fullness and early satiety, a splenectomy was performed; the patient was provided with penicillin and was advised to take it in the event of infection. Six years before admission the white-cell count rose as high as 155,000, and busulfan was begun. One year later an x-ray film.
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