title: Generalized lymphadenopathy secondary to an invasive fungal infection in an apparently healthy patient.
abstract: A 47-year-old woman with a history of anemia and deep vein thrombosis presented to the hospital with worsening leg edema despite treatment with warfarin. Initial laboratory results revealed leukopenia, anemia and abnormal liver enzymes. Computed tomography and positron emission tomography scans showed generalized lymphadenopathy. Cultures were negative, and lymph node and bone marrow biopsies were inconclusive. Because her clinical presentation suggested malignancy, 2 distinct regimens of empiric chemotherapy were given. She was also treated with antibiotics and antifungal drugs. After 1 month of hospitalization, the patient died. Her autopsy revealed an invasive fungal infection consistent with aspergillosis but no malignancy. Histologic studies of the lymph nodes revealed reactive inflammation without fungi. Generalized lymphadenopathy is an unusual presentation of aspergillosis, and only a few cases have been reported in patients without predisposing risk factors. These cases had granulomatous inflammation. This case demonstrates that invasive aspergillosis should be considered in patients with diffuse lymphadenopathy.
authors.affiliation: Departments of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas 79430, USA.
authors.forename: Eva
authors.initials: E
authors.lastname: Nourbakhsh
authors.forename: Samantha
authors.initials: S
authors.lastname: Goodman
authors.forename: Stewart
authors.initials: S
authors.lastname: Nash
authors.forename: Kenneth
authors.initials: K
authors.lastname: Nugent
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications* / Q000188:drug therapy; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D008206:Lymphatic Diseases / Q000209:etiology* / Q000473:pathology; D008223:Lymphoma / Q000175:diagnosis / Q000188:drug therapy; D008875:Middle Aged
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents