PHOTO QUIZ Anthony Amoroso, Section Editor
An Unusual Pain in the Neck (See pages 1638–9 for the Answer to the Photo Quiz.)
Figure 1. Fluorodeoxyglucose positron emission tomography–computed tomography (whole body) demonstrating increased metabolic uptake in bilateral cervical chains, predominately on the left and adjacent tonsillar bed. There was no additional nodal or extranodal pathological uptake.
QUESTION A 40-year-old man with no relevant medical history was referred to a tertiary referral cancer center with a 2-month history of cervical adenopathy, tonsillar swelling, and odynophagia in the absence of constitutional symptoms. Clinical examination revealed left cervical adenopathy with associated tonsillar swelling without exudates. Routine laboratory investigations were unremarkable except for elevated lactate dehydrogenase (276 U/L) and C-reactive protein levels (27 mg/L). Cytomegalovirus and Epstein-Barr virus serology was consistent with past exposure, whereas serology for human immunodeficiency virus, hepatitis B, and hepatitis C was negative. Predominate left-sided cervical chain adenopathy was confirmed with
Figure 3. Clinical photo of chest with evidence of delayed-onset maculopapular exanthem.
fluorodeoxyglucose positron emission tomography–computed tomography (Figure 1), consistent with presumed primary Hodgkin lymphoma. Excisional cervical node biopsy was
PHOTO QUIZ
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CID 2014:58 (1 June)
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1577
Downloaded from http://cid.oxfordjournals.org/ at Dartmouth College Library on January 7, 2015
Figure 2. Specialized immunohistochemical stain of excised cervical node (×400 magnification).
negative for malignancy, so supplementary Warthin-Starry staining and specialized immunohistochemistry were requested (Figure 2). At time of biopsy, a delayed-onset widespread maculopapular skin eruption was noted (Figure 3).
Clinical Infectious Diseases 2014;58(11):1577–8 © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@ oup.com. DOI: 10.1093/cid/ciu153
Downloaded from http://cid.oxfordjournals.org/ at Dartmouth College Library on January 7, 2015
1578
•
CID 2014:58 (1 June)
•
PHOTO QUIZ
An Unusual Pain in the Neck (See pages 1638–9 for the Answer to the Photo Quiz.)
Figure 1. Fluorodeoxyglucose positron emission tomography–computed tomography (whole body) demonstrating increased metabolic uptake in bilateral cervical chains, predominately on the left and adjacent tonsillar bed. There was no additional nodal or extranodal pathological uptake.
QUESTION A 40-year-old man with no relevant medical history was referred to a tertiary referral cancer center with a 2-month history of cervical adenopathy, tonsillar swelling, and odynophagia in the absence of constitutional symptoms. Clinical examination revealed left cervical adenopathy with associated tonsillar swelling without exudates. Routine laboratory investigations were unremarkable except for elevated lactate dehydrogenase (276 U/L) and C-reactive protein levels (27 mg/L). Cytomegalovirus and Epstein-Barr virus serology was consistent with past exposure, whereas serology for human immunodeficiency virus, hepatitis B, and hepatitis C was negative. Predominate left-sided cervical chain adenopathy was confirmed with
Figure 3. Clinical photo of chest with evidence of delayed-onset maculopapular exanthem.
fluorodeoxyglucose positron emission tomography–computed tomography (Figure 1), consistent with presumed primary Hodgkin lymphoma. Excisional cervical node biopsy was
PHOTO QUIZ
•
CID 2014:58 (1 June)
•
1577
Downloaded from http://cid.oxfordjournals.org/ at Dartmouth College Library on January 7, 2015
Figure 2. Specialized immunohistochemical stain of excised cervical node (×400 magnification).
negative for malignancy, so supplementary Warthin-Starry staining and specialized immunohistochemistry were requested (Figure 2). At time of biopsy, a delayed-onset widespread maculopapular skin eruption was noted (Figure 3).
Clinical Infectious Diseases 2014;58(11):1577–8 © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@ oup.com. DOI: 10.1093/cid/ciu153
Downloaded from http://cid.oxfordjournals.org/ at Dartmouth College Library on January 7, 2015
1578
•
CID 2014:58 (1 June)
•
PHOTO QUIZ
