Bone marrow examination is usually nondiagnostic. Patients usually have a rapid downhill course and die of infection if left untreated or misdiagnosed. Patients with Franklin disease usually have a history of progressive weakness, fatigue, intermittent fever, night sweats and weight loss and may present with lymphadenopathy (62%), splenomegaly (52%) or hepatomegaly (37%). The fever is considered secondary to impaired cellular and humoral immunity, and thus recurrent infections are the common clinical presentation in Franklin disease. Weng et al. described the first case of Penicillium sp. infection in a patient with Franklin disease and emphasized the importance of proper preparation for biopsy, complete hematologic investigation, culture preparation and early antifungal coverage to improve the outcome.The γHCD can be divided into three categories based on the various clinical and pathological features. These categories are disseminated lymphoproliferative disease, localized proliferative disease and no apparent proliferative disease. Disseminated lymphoproliferative disease is found in 57-66% of patients diagnosed with γHCD. Lymphadenopathy and constitutional symptoms are the usual features. Localized proliferative disease is found in approximately 25% of γHCD patients. This is characterized by a localization of the mutated heavy chains in extramedullary tissue, or solely in the bone marrow. No apparent proliferative disease is seen in 9-17% of patients with γHCD, and there is almost always an underlying autoimmune disorder. IgM/μHCD
The IgM type of heavy chain disease, μHCD, is often misdiagnosed as chronic lymphoid leukemia (CLL) because the two diseases are often associated with each other and show similar symptoms. References


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Pes anserinus ("goose foot") refers to the conjoined tendons of three muscles of the thigh. It inserts onto the anteromedial (front and inside) surface of the proximal tibia. The muscles are the sartorius, gracilis and semitendinosus sometimes referred to as the guy ropes. The name "goose foot" arises from the three-pronged manner in which the conjoined tendon inserts onto the tibia. Structure
The three tendons, from front to back, that conjoin to form the pes anserinus come from the sartorius muscle, the gracilis muscle, and the semitendinosus muscle. It inserts onto the proximal anteromedial surface of the tibia.The pes anserinus is around 5 cm below the medial tibial joint line. It lies superficial to the tibial insertion of the medial collateral ligament of the knee. Clinical significance
Pes anserine bursitis is a cause of chronic knee pain and weakness. It occurs when the medial portion of the knee is inflamed. If the bursa underlying the tendons of the sartorius, gracilis, and semitendinosus gets irritated from overuse or injury, a person can develop this ailment. This condition usually occurs in athletes from overuse. This pathology is characterized by pain, swelling, and / or tenderness.The semitendinosus tendon can be used in certain techniques for reconstruction of the  anterior cruciate ligament. History
The name "goose foot" arises from the three-pronged manner in which the conjoined tendon inserts onto the tibia. Additional Images
References
External links
Pes anserinus at the Duke University Health Systems Orthopedics program