Introduction:

Lymphoproliferative disorders can represent a real diagnostic challenge. This clinical case highlights the difficulty that sometimes exists in the diagnosis of lymphoproliferative diseases, and the importance of the family doctor FD in the integration of clinical information from different sources to arrive at a diagnosis.

Case description:

A 54-year-old man went to the emergency department ED due to low back and abdominal pain and got a diagnosis of pyelonephritis. Later FD evaluated this patient and sent him again to the ED due to an unfavorable evolution of the symptoms. In the ED, he performed more complementary diagnostic tests; however, the results of which were not valued, and the patient had medical release again. He was reevaluated another time by his MF, who discussed the clinical case with other medical specialties, having then arrived at the hypothesis of a diagnosis of proliferative disease and given the indication of urgent referral for a hematology consultation. The patient goes for the third time to the ED due to worsening symptoms and is finally hospitalized for study, having established the diagnosis of B cell indolent lymphoma.

Comment:

This clinical case highlights the difficulty and the delayed diagnosis that can occur in lymphoproliferative disease. In an urgent context, the best guidance is not always given to patients, so the FD’s critical attitude and the constant struggle for the patient’s best interest made all the difference in this patient. They undoubtedly do in many other similar cases.

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