An icteric tongue

An icteric tongue (from N Engl J Med 2021; 385:e16. DOI: 10.1056/NEJMicm2034755)

A 12-year-old boy presented with a 4-day history of sore throat and dark urine. He was found to have jaundice with an icteric tongue, and the hemoglobin level was 6.1 g per deciliter. A diagnosis of cold agglutinin, EBV-induced acute hemolytic anemia was made.

Author’s note: Cold agglutinin disease (CAD) is a form of autoimmune hemolytic anemia (AIHA) in which cold agglutinins (IgM autoantibodies against red blood cell [RBC] antigens that bind at cold temperatures) can cause clinical symptoms related to RBC agglutination in cooler parts of the body and hemolytic anemia.

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