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

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


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.


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.


CD3. CD20. HSV 1 & 2.



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


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