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A previously well 69-year-old British man presented with a 4-week history of anorexia, weight loss, drenching night sweats, marked lethargy and abdominal pain. Examination revealed pleural effusions and gross ascites. There was no jaundice, fever, cough, signs of chronic liver disease or palpable lymphadenopathy. Investigations revealed a haemoglobin 12.9 g/dl, white cell count 11.3×109/litre, neutrophils 10.4×109/litre, platelets 704×109/litre; creatinine of 107 μmol/l; normal liver enzymes; corrected calcium of 2.23 mmol/l; lactate dehydrogenase 4640 U/l (normal 125–243 U/l); urate 1201 μmol/l (normal <450 μmol/l) and negative HIV serology. CT chest and abdomen (figures 1 and 2) were performed. The patient's poor condition …
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