BACKGROUND
This 43-year-old man presents to his primary care physician because of polycythemia that has lasted 1 year. His hemoglobin level is 14.8 g/dL. He has no other symptoms, though he has a 25 pack-year smoking history and a history of gross hematuria 1 month ago. Evaluation reveals findings consistent with a urinary tract infection.
Three weeks after that evaluation, he presents to the emergency department with abdominal pain and hematuria but no weight loss. Laboratory tests reveal a hemoglobin level of 15.8 g/dL, a hematocrit concentration of 56%, an erythropoietin level of 14 mU/mL (within normal limits), oxygen saturation of 97%, no splenomegaly, no leukocytosis, and no thrombocytosis. Bone marrow biopsy reveals findings consistent with secondary polycythemia. He undergoes CT of the abdomen.
What is the diagnosis?
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Hint
This is a rare cause of polycythemia.
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Author:
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Mable W. Tan, MD, Assistant Professor, Department of Geriatrics, University of Oklahoma City, and Winston W. Tan, MD, FACP, Assistant Professor, Department of Hematology Oncology, Mayo Clinic Jacksonville
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eMedicine Editor:
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Sat Sharma, MD, Associate Professor, University of Manitoba, Department of Medicine, Division of Pulmonary Medicine
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eMedicine Case
