Case 392 -- A female in her 20s with pharyngitis, odynophagia, dysphagia

Contributed by Allene Gagliano, MD
Published on line in June, 2004


CLINICAL HISTORY:

26 year old female presented with a 3-4 week history of pharyngitis, odynophagia and dysphagia. She had initially been treated with two courses of Augmentin (amox/clav) and one course of Avelox (moxifloxacin), and her symptoms seemed to improve, but then came back to the point where she was having trouble swallowing and had airway problems, with a fever as high as 104.7F.

On exam, she had marked cervical lymphadenopathy, as well as axillary lymphadenopathy, tonsils 2+ to 3+ (L > R), with exudates. She also had a few small nodes in the groin area which she stated she'd had 8 weeks before. She was also noted to have a genital lesion on her labia that was cultured for viral and herpetic activity. Herpes simplex virus was isolated. WBC count was 16.9 x 109/L at time of admission. A tonsillectomy was performed at an outside hospital and sent to UPMC on consult.

HISTOMORPHOLOGY:

Hyperplastic follicles with few remaining germinal centers, surrounded by interfollicular expansion.
Polymorphous interfollicular expansion composed of small lymphs, transformed cells, histiocytes and plasma cells.
Monocytoid B-cells surrounding crypt epithelial cells.
Areas of necrosis.
Multinucleated cells with characteristic "molding" of nuclei and margination of chromatin to the periphery of the nucleus.
Same as above.

IMMUNOSTAINS:

CD3. CD20. HSV 1 & 2.

OTHER PERTINENT IMMUNOSTAINS PERFORMED:

OTHER RESULTS:

CMV serologies negative.
EBV serologies indicate prior infection, but no active infection.

FINAL DIAGNOSIS


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