Physical exam revealed an enlarged spleen and right axillary lymph node. Her bloodwork is remarkable for an elevated lactate dehydrogenase (LDH) of 550 U/L and a creatinine of 2.0 mg/dL. Mrs. Reynolds is a retired actress and lifelong nonsmoker who drinks 1 to 2 glasses of wine a week and denies illicit drug use. Her health history includes the vaginal delivery of two healthy babies in her 20s and hypercholesterolemia, which has been controlled by diet.
