Case 6-1972

Presentation of CaseA 73-year-old woman was admitted to the hospital because of dehydration.For several years she had been treated with prednisone and chlorambucil because of chronic lymphocytic leukemia. During the six months before entry she experienced severe dysphagia with substernal burning, which was unrelated to exertion, was imperfectly relieved by antacids and largely prevented the ingestion of solid foods. She lost 11 kg in weight. Four months before admission she was treated for a febrile illness believed to be due to urinary-tract infection and cholecystitis, and mild dysuria persisted thereafter. Six weeks before entry, after a fall, peripheral . . .