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.|
OTHER PERTINENT IMMUNOSTAINS PERFORMED:
|CD15:||No RS-like staining|
|CD45:||numerous + cells|
|CD30:||No RS-like staining|
|Kapa/Lamda:||both many scat. cells little staining in pale cell areas|
|bcl2:||GCs "-" as well as|
|bcl6:||many "+" cells in GCs|
|CD10:||GCs "+" in patchy/weak stain w/bg staining|
|CD43:||sim. to CD3; B-cells negative|
|EBER-ish:||rare scat. "+" cells|
CMV serologies negative.
EBV serologies indicate prior infection, but no active infection.