Presentation of Case A 51-year-old woman was admitted to the hospital because of progressive abdominal distention. She was well until 12 years earlier, when hypothyroidism and pernicious anemia were found; vitamin B12 and levothyroxine were begun. Seven years before admission hypertension developed, and hydrochlorothiazide was prescribed. Three years before entry the hematocrit was 60 percent, the white-cell count 16,000, and the platelet count 900,000; the leukocyte alkaline phosphatase was elevated, and a radionuclide liver–spleen scan revealed enlargement. In a specimen of arterial blood the partial pressure of oxygen (PaO2) was normal, and an intravenous urographic examination was negative….
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