Persisting Delirium as a Presenting Feature of an Underlying Myeloproliferative Neoplasm in Elderly

A 71 year old female presented with an unusually long course of persisting delirium and a rapid downhill functional decline. She presented with progressive symptoms over a course of year with confused behaviour, sleep disturbances, irrelevant talk and restlessness followed by difficulty in walking, falls, speech disturbances, generalized weakness of six months duration and decreased appetite with urinary and stool incontinence of 2 week duration. Her lab reports had shown consistently abnormal blood counts for 4 years before hospitalisation. The abnormalities from peripheral blood smear and GBP (general blood picture) showed elevated platelet count, total leucocyte count and decreased red blood cell count and haemoglobin level. Investigations for myeloproliferative neoplasm (MPN) included the Reflex profile (JAK mutations on qualitative RT-PCR), and bone marrow biopsy (increased megakaryocytes suggestive of Essential thrombocythemia). Patient was started on Oral Hydroxyurea along with oral anti platelet and hypolipidemic drugs. Six months post chemotherapy initiation remained asymptomatic.   Keywords: elderly, delirium, myeloproliferative, neoplasia.