A 75-year-old man presents to his physician with flu-like symptoms. He has a fever of 102 °F and he looks haggard and complains of overwhelming fatigue. Three years prior, he presented with no past medical history and widespread lymphadenopathy and significant splenomegaly. Imaging then revealed a retroperitoneal mass that extended into a mesenteric mass. On the basis of laboratory testing, imaging, and a lymph node biopsy, mantle cell lymphoma (MCL) was diagnosed. The patient was prescribed ibrutinib, which was well tolerated, and he went into remission.

At the exam, he has significant splenomegaly, palpable liver edge, petechial rash on his legs, as well as lower-extremity edema. He appears tired. Vital signs reveal a normotensive patient with tachycardia and tachypnea, with normal oxygen saturation on ambient air. His performance status score is 1.