Severe adult protein-energy malnutrition mimicking haematological malignancy: diagnostic lessons from a profound pancytopenia

A 53-year-old man with insulin-treated type 2 diabetes mellitus and a three-month history of food refusal driven by an untreated major depressive episode presented with pancytopenia (haemoglobin 30 g/L, white cell count 1.48 × 10⁹/L, platelets 14 × 10⁹/L), hepatosplenomegaly, polyserositis, polyclonal hypergammaglobulinaemia (IgG 44.35 g/L), disseminated intravascular coagulation, and a markedly elevated lactate dehydrogenase (LDH 3877 U/L).